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Full text of "U.S. Navy Medicine Vol. 69, No. 9 September 1978"







J2M5W 

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September 1978 



VADM WillartJ P. Arentzen, MC, USN 

Surgeon General of the Navy 

RADM R.G.W. Williams, Jr., MC, USN 
Deputy Surgeon General 

Director of Public Affairs 

ENS Richard A. Schmidt, USNR 

Managing Editor 

Ellen Casselberry 

Assistant Editor 

Virginia M. Novinski 

Editorial Assistant 

Nancy R. Keesee 

Contributing Editors 
Contributing Editor-in-Chief: CDR C.T. 
Cloutier (MC); Aerospace Medicine: 
CAPT M.G. Webb (MC); Dental Corps: 
CAPT R.D. Ulrey (DC); Education: 
CAPT S.J. Kreider (MC); Fleet Sup- 
port: LCDR J.D. Schweitzer (MSC); 
Gastroenterology: CAPT D.O. Castell 
(MC); Hospital Corps: HMCM H.A. 
Olszak; Legal: LCDR R.E. Broach 
(JAGC); Marine Corps: CAPT D.R. 
Hauler (MC); Medical Service Corps: 
CAPT P.D. Nelson (MSC); Naval Re- 
serve: CAPT J.N. Rizzi (MC, USN); 
Nephrology: CDR J.D. Wallin (MC); 
Nurse Corps: CAPT P.J. Elsass (NC); 
Occupational Medicine: CDR J.J. Bel- 
lanca (MC); Preventive Medicine: 
CAPT D.F. Hoeffler (MC); Psychiatry: 
CAPT S.J. Kreider (MC); Research: 
CAPT J. P. Bloom (MC); Submarine 
Medicine: CAPT J.C. Rivera (MC) 



POLICY: U.S. Navy Medicine is is official publication 
of the Navy Medical Department, published by the Bureau 
of Medicine and Surgery. It disseminates to Navy Medical 
Department personnel official and professional information 
relative to medicine, dentistry, and the allied health sci- 
ences. Opinions expressed are those of the authors and do 
not necessarily represent the official position of the Depart- 
ment of the Navy, the Bureau of Medicine and Surgery, or 
any other governmental department or agency. Trade 
names are used for identification only and do not represent 
an endorsement by the Department of the Navy or the Bu- 
reau of Medicine and Surgery. Although U.S. Navy Medi- 
cine may cite or extract from directives, official authority for 
action should be obtained from the cited reference. 

DISTRIBUTION: U.S. Navy Medicine is distributed to 
active-duty Medical Department personnel via the Standard 
Navy Distribution List. The following distribution is author- 
ized: one copy for each Medical, Dental, Medical Service 
and Nurse Corps officer: one copy for every 10 enlisted 
Medical Department members. Requests to increase or de- 
crease the number of allotted copies should be forwarded to 
U.S. Navy Medicine via the local command. 

CORRESPONDENCE: All correspondence should be 
addressed to: Editor, US. Navy Medicine. Department of 
the Navy. Bureau of Medicine and Surgery (Code 0010), 
Washington, D.C. 20372. Telephone: (Area Code 202) 254- 
4253, 254-4316, 254-4214; Autovoo 294-4253, 294-4316. 294- 
4214. Contributions from the field are welcome and will be 
published as space permits, subject to editing and possible 
abridgment. 

The issuance Df this publication is approved in accordance 
with Department of the Navy Publications and Printing 
Regulations (NAVEXOS P-35). 



U.S.NAVY 




Vol. 69, No. 9 
September 1978 



1 From the Surgeon General 

2 Department Rounds 

At NNMC Bethesda, Group Therapy Puts a Focus on the Family 

6 Notes and Announcements 

8 Scholars' Scuttlebutt 

The Medical School Liaison Officer 

10 Instructions and Directives 

12 Features 

Naval Aviation Physiology 
LCDR T.J. O'Leary, MSC, USN 

18 Hospital Corps Career Decision: The Time Is Now! 

19 Roster— 1 August 1978 

Staff Medical and Dental Officers at Major Activities 

23 NAVMED Newsmakers 

24 Professional 

Bezoar: An Unusual Complication of Surgery for Dumping Syndrome 
LCDR G.S. Weinstein, MC, USNR 

27 Treatment of Chronic Bacterial Prostatitis with Trimethoprim-Sul- 
famethoxazole 
LCDR D.F. Lynch, Jr., MC, USN 

29 BUMED SITREP 



COVER: Disabling illness, such as "stroke," is a "personal crisis for the 
patient — and a crisis for the whole family," says Ms. Lala Johnson, 
Chief of Social Work Service, NNMC Bethesda. In cooperation with 
NNMC's Neurological Service, she has begun a unique group therapy 
program for "caretakers" of disabled patients (see page 2). Photo re- 
printed by permission of the American Heart Association. 



NAVMED P-5088 



From the Surqeon General 



'I Am a Patient' 



The following — written by CDR 
Joseph Smyth (MC) — was sent to 
me from Yokosuka. It so impressed 
me that I wish to insert it instead of 
my own letter to you this month. 

You've seen me a hundred times — 
with many faces, many forms, many 
reasons for being in your care. 

I am the frightened, middle-aged 
sailor, waiting at your admitting desk, 
nervously opening and closing my 
wallet. 

I am the shuffling, stoop-shouldered 
figure in faded blue pajamas you en- 
counter at every corner as you go about 
your daily work. 

Everything is new and strange to me. 
Yesterday I was in familiar surround- 
ings and happy, planning my tomor- 
rows. Today 1 am in an alien world, try- 
ing hard to adjust. The little familiar 
things of my own world seem to take on 
great importance. 1 may complain to 
you. I may rebel against the strange- 
ness. You see, I don't want to be in the 
hospital; I want to go back to my ship. 

From the moment I walk up to your 
admitting desk, I am a mass of fears; I 
am fearful of the unknown. 1 am 
alarmed over the prospect of pain, dis- 
figurement — even death. I fear financial 
distress or catastrophe. More than any- 
thing else, I am lonely. 

If 1 tell you my coffee is cold, it may 
be because coffee is more than a break- 
fast drink to me. . . . Through years of 
experience I have come to associate it 
with congeniality, friendship, the 
warmth and security of shipmates. 
. . . [C]old coffee reminds me that I am 
among strangers, antiseptic and some- 



how frightening strangers. 

When I object to early morning awak- 
ing, I often mean that I am insecure. 
When I report that my nurse or doctor is 
indifferent, I often mean I feel forsaken. 

Please understand that often, in my 
complaints about little things, I am try- 




VADM Arentzen 

ing to tell you of far deeper needs. Will 1 
lose my identity? Will I be exposed to all 
. . . sorts of indignities? 

I'm afraid that I'll be treated, not as a 
sailor, but as a "fascinating gall blad- 
der," an "interesting thyroid." I ap- 
pear normal, but I have left normalcy 
outside your door. Though I am mature, 
I have suddenly become a child, 
frightened of the long, dark nights. 



And, oh, how I want you to be warm and 
friendly! . . . 

You may tell me that . . . some ' 'dis- 
comforts," some "fears" are part of 
any hospital stay. I will tell you that I 
understand this perfectly when I am not 
a patient, but from the minute I enter 
your hospital, my outlook changes. 
Minor things take on abnormal impor- 
tance. 

Much of my fright . . . comes from 
lack of understanding on my part. All 
too often you take for granted that I 
know these things, and I'm left to grope 
for my answers alone. , . . 

Help me bridge my initial feelings of 
embarrassment. Assure me that the 
bedpan is only temporary and that as I 
improve I'll be able to look after myself 
to a greater degree. Assure me that I 
am never alone or abandoned, even on 
the busiest hospital day. Reassure me 
that my struggle is not a private one — 
that my feelings, frustrations, resent- 
ments, and emotions are simply a part 
of being a patient. 

Never forget, you've been a symbol to 
people like me ever since the Samari- 
tan traveled the road between Jerusa- 
lem and Jericho two thousand years 
ago. The equipment and the methods 
have changed. But the concept con- 
tinues unchanged. 

You're the benevolent healer. You 
cannot — you dare not — change! 



/ 



W.P. ARENTZEN 

Vice Admiral, Medical Corps 

United States Navy 




Volume 69, September 1978 



Department Rounds 



At NNMC Bethesda, group therapy for 'caretakers' 
of disabled patients puts a . . . 

Focus on the Family 



"You do everything to help the 
patients. Why don't you do some- 
thing to help the families? " 

For Ms. Lala Johnson, who heads 
the Social Work Service at the Na- 
tional Naval Medical Center, Be- 
thesda, Md., this anguished out- 
burst hit home with special force. 
She herself, like the woman who 
confronted her, had had a close 
family member disabled by crip- 
pling "stroke." 

"That's an excellent idea," she 
responded. "Can you identify 
enough families with similar prob- 
lems so that we could start a 
group?" 

Thus, two years ago, she 
launched a unique program of 
group therapy for family members 
who are "caretakers" of patients 
with chronic, disabling disorders. 

The Bethesda group is the first of 
its kind to be formed at a Navy 
medical facility — and perhaps the 
first anywhere. Most of its current 
members are spouses of patients 
who have been discharged from the 
NNMC Neurology Service and are 
disabled, to varying degrees, by 
such disorders as stroke, dementia, 
and multiple sclerosis. 

The range of disabilities with 
which these patients and their fam- 
ilies must cope includes hemiplegia, 
hemiparesis, aphasia, loss of blad- 
der and bowel control, and loss of 
mental function. For most of the 
patients, regression is inevitable. 




mm 



In the hospital, trained personnel and special facilities are available 



U.S. Navy Medicine 



One member summed up the 

purposes of NNMC's family group 
as follows: 

"to maintain our mental health; 

' 'to share our experiences so as to 
help others; 

' 'to try to obtain some interest in 
the way of facilities or help for those 
afflicted." 

The group, small enough so that 
members can draw their chairs into 
an informal circle, meets weekly at 
NNMC for about an hour and a half. 

Ms. Johnson — a slight, soft-spo- 
ken woman with a warming smile — 
provides unobtrusive leadership: 
suggesting here, softly probing 
there, nudging the talk along when 
expression of feelings becomes dif- 
ficult, and gently but firmly insist- 
ing on confrontation of painful is- 
sues. LCDR E. Wayne Massey, 
MC, USNR — a young neurologist 
who, like Johnson, has had experi- 
ence with stroke in his own family — 
serves as co-leader and as a re- 
source on medical queries. 

Above all, the group furnishes a 
supportive atmosphere in which 



members can express, and begin to 
deal with, the devastating emotions 
generated in them by a world that 
illness has turned upside down. 

There's a profound sense of shar- 
ing here — not only of feelings, but 
of constructive, practical ideas 
traded among people who deal with 
similar problems. No visitor to the 
group can fail to be impressed by its 
members' sharp humor, gallantry, 
vitality, and real strength. 

A primary emotion ventilated in 
the group is grief. 

One husband of a woman with a 
progressive neurological disorder 
expressed his continuing sense of 
mourning and loss as — from week 
to week, from month to month — his 
wife loses more of her ability to 
function. "It has just become too 
much to bear," he said, "too much 
to bear." 

Others speak of their loneli- 
ness — of the deprivation of com- 
panionship from formerly close 
spouses whose mental function is 
now impaired: "The hardest thing 




but after discharge, care will take place at home. 



is that there's no one to talk to" . . . 
"She's there, but she's not there." 

What these families are mourn- 
ing, Johnson points out, is really a 
kind of death — a death of part of the 
patient's body — and the disruption 
of close relationships that inevitably 
results. Indeed, she says, family 
members seem to go through stages 
similar to those described by 
Kiibler-Ross in her now classic book 
On Death and Dying — with one ex- 
ception. While the stages of denial, 
anger, and depression are fre- 
quently seen, the final stage eludes 
attainment. 

"I thought the members would 
work through their feelings, reach 
the stage of acceptance, and leave 
the group," Johnson says, "but so 
far that just hasn't happened. 1 
don't think they ever really reach 
acceptance." 



"No one who hasn't been through 
this experience can ever really un- 
derstand what it's like," says one 
group member — a sentiment 
echoed by all. For the caretaker in 
these situations is on duty 24 hours 
a day: cleaning house; providing the 
patient's meals on time; feeding, 
bathing, clothing, and grooming 
those who can't perform these 
functions unassisted (or at all); 
cleaning up after the incontinent; 
helping the ambulatory patient get 
around; in the case of some pa- 
tients, simply being there, in every 
spare moment, hoping for some 
glimmer of recognition or response. 

What most of us think of as 
simple matters — dressing, and such 
grooming tasks as clipping finger- 
nails and toenails — may take the 
caretaker hours to accomplish for a 
patient who is unable to cooperate. 
If the patient is incontinent and un- 
able to communicate, the caretaker 
tries desperately to anticipate 
needs, and thus avert accidents. In 



Volume 69, September 1978 



some cases, patients may be ambu- 
latory but incontinent; thus, every 
outing must be carefully planned to 
keep the patient always within close 
range of a toilet. In cases of de- 
mentia, the caretaker may fear 
leaving the house long enough to go 
to the corner store: a patient who 
smokes, left alone, could burn the 
house down. 

Of his two years with the group, 
Dr. Massey says: "One thing I've 
realized more and more is how re- 
strictive this situation is for the pa- 
tient's spouse." All too frequently, 
relatives or friends who could help, 
by staying with the patient long 
enough to give the caretaker a brief 
respite, withdraw from the scene, 
murmuring excuses; "I just can't 
stand to see him (her) that way ..." 

In a very real sense, Ms. Johnson 
points out, the caretaker is a cap- 
tive. He or she, no matter how lov- 
ing, is caught in a no-exit bind that 
elicits frustration, anger, and a de- 
sire to escape — emotions closely 
followed by overwhelming guilt. 

"Is it normal to have these feel- 



ings; 



one caretaker asked. An 



important function of the group is to 

assure members that these feelings 
are indeed most "normal," as are 
some even more difficult to express. 

When, as in some cases, a family 
member can anticipate perhaps 20 
or 30 more years of trying to cope, 
in an agonizing and ever-worsening 
situation, it's small wonder that the 
only way out may seem to be his or 
her own death — or that of the 
patient. And it's also small wonder 
that it was more than a year before 
group members could bring them- 
selves to talk of these inevitable 
feelings about suicide and homi- 
cide — feelings that, of course, have 
nothing to do with intention to act. 

Indeed, says Johnson, "One of 
the greatest fears the caretakers 
express is that they may die before 
the patient does. Then who will take 
care of him?" 




If what has been said so far Recovery is a team effort for therapists, patient, and family. 



U.S. Navy Medicine 



sounds dismal, the basic tone of the 
group is far from that. The constant 
focus is on coping — or, as Johnson 
puts it, on "helping the family con- 
trol the disability, rather than 
letting the disability control the 
family." 

For the caretaker, one of the most 
useful of all coping mechanisms is a 
brief "escape" from home. Indeed, 
his or her own health may require it. 
But finding someone else to take 
temporary charge of the patient's 
care isn't easy. And even when 
suitable arrangements can be 
made, the caretakers seem to find it 
almost impossible to leave their pa- 
tients, even for a few hours. (Said 
one husband, "I feel as though I'm 
abandoning her.") 

Nonetheless, Johnson and Mas- 
sey continually stress the need for 
family members to get away from 
time to time — for part of a day, a 
weekend, a week, or whatever they 
can work out. And members of the 
group who have made their own 
first "escapes" offer strong en- 
couragement to the others to do 
likewise. 

Humor and fantasy are also 
important mechanisms in coping, as 
a recent group session illustrated. 

One woman reported that a travel 
brochure she had recently run 
across had prompted a week of 
happy fantasizing. In her scenario, 
Dr. Massey called her husband back 
into the hospital for study, just long 
enough so that she could go on a 
long-dreamed-of vacation. 

To general laughter, another 
member suggested that the fantasy 
would have been perfect had she 
also dreamed up a doctor's order 
not to visit her husband during his 
hospital stay — thus averting any 
possible feelings of guilt. 

While the members of the group 
support each other by sharing prob- 
lems and working together to find 
ways to solve them, they also draw 
strength from broader community 
aims. 

Having themselves found the 



support of the group invaluable, 
they hope their experience will 
spark other efforts to help families 
in similar plights. To this end, they 
have generously invited visitors 
from various "helping" agencies to 
sit in on sessions, ask questions, 
and learn firsthand something of 
the problems families with disabled 
members face. 

Both Johnson and Massey are es- 
pecially interested in seeing the 
group idea take root at other facili- 
ties besides NNMC. Social workers 
in the Navy are scarce indeed, 
Johnson acknowledges. However, 
she points out, professionals in 
other disciplines with experience in 
group dynamics — psychiatrists and 
chaplains, for example — could lead 
this type of group just as well. 

"You need the skills in group 
techniques," she says, "but more 
important than anything else is the 
interest!" 

One great problem for doctors in 
dealing with the disabled, says 
Massey, is that "they are operating 
in a vacuum — they don't see the 
patient in the family context." Yet, 
he points out, stroke patients at 
NNMC, for example, stay in the 
hospital for six weeks at most, and 
usually go home after two or three. 

On NNMC's Neurology Service, 
the social worker is involved with 
the family from the beginning of a 
new patient's hospital stay. (Ideal- 
ly, the first contact with referred 
families is made within 24 hours 
after the patient's admission.) Ms. 
Johnson's hope is to bring family 
members into the group right away, 
so they'll be better prepared for 
what they'll have to face when the 
patient goes home. 

One area frequently overlooked 
by the doctor dealing with disabled 
patients, says Massey, is sex. He 
himself used to be guilty of this, he 
says, and he attributes his new 
sensitivity on the subject to what he 
has learned in the group: "Two 
years ago, when patients came back 



to the clinic, I didn't ask questions 
about sexual function. Now I try to 
ask everyone, and patients will say 
with relief, 'Well, now that you 
ask . . .'" 

In some cases, problems with 
impotence can be relieved — for 
example, one patient is now happily 
functioning after implant of a penile 
prosthesis. Couples who have diffi- 
culty in achieving intercourse be- 
cause of the partial paralysis of one 
partner may be helped by counsel- 
ing on new positions. 

But whether or not a sexual prob- 
lem is susceptible to solution, 
spouses in such situations need 
sympathetic understanding in what 
can be agonizing personal dilem- 
mas. 

The problems this article has dis- 
cussed by no means exhaust the 
catalog of difficulties that beset 
families of the disabled. Financial 
worries, for example, about patients 
who will sooner or later require 
nursing-home care have not even 
been touched on. 

Recently, a member of the group 
expressed his anger toward a 
physician who had examined his 
wife and seemed indifferent to signs 
of regression she was exhibiting. 
"Well, this is the kind of thing 
you've got to expect," the doctor 
told him. "She's not going to get 
any better; she's going to get 
worse." 

"I didn't need anyone to tell me 
she's not going to get better — I 
knew that," the husband com- 
mented indignantly. 

Dr. Massey pointed out that the 
physician's disappointing response 
could well have resulted from a feel- 
ing of helplessness because there 
was nothing he could do. 

"i can have sympathy for that," 
said Massey. "It's been two years 
since I came into the group, and my 
reaction to this type of situation has 
altered. 

"The group has been teaching 
me, and I'm still learning." 



Volume 69, September 1978 



Notes & Announcements 



Dental continuing education courses . . . The follow- 
ing dental continuing education courses will be offered 
in December 1978; 

National Naval Dental Center, Bethesda, Md. 

Endodontics 4-6 Dee 1978 

Comprehensive Dentistry 11-14 Dec 1978 

Eleventh Naval District, San Diego, Calif. 
Fixed Partial Dentures 



4-6 Dec 1978 



U.S. Army Institute of Dental Research, Walter Reed 
Army Medical Center, Washington, D.C. 

Preventive Dentistry 4-7 Dec 1 978 

Letterman Army Medical Center, San Francisco, Calif. 
Restorative Dentistry 4-7 Dec 1 978 

Requests for courses administered by the Comman- 
dant, Eleventh Naval District, should be submitted to: 
Commandant, Eleventh Naval District (Code 37), San 
Diego, Calif. 92132. Applications for other dental con- 
tinuing education courses should be submitted to: 
Commanding Officer, Naval Health Sciences Education 
and Training Command (Code 5), National Naval Med- 
ical Center, Bethesda, Md. 20014. Applications should 
arrive six weeks before the course begins. 



AFIP courses offered • . . The Armed Forces Institute 
of Pathology will offer the following courses: 

Seminars in Diagnostic Radiology 13-17 Nov 1978 

These seminars are designed to offer radiology practitioners a sum- 
mary of the most important morphological principles that underlie the 
evaluation of roentgenologic signs. Materials have been carefully 
chosen to achieve maximum radiologic-pathologic correlation in the 
elucidation of disturbed morphology as seen on roentgenograms. 

Applicants should be members of the Medical Corps 
of the Armed Forces or federal services, or civilians 
with specialty training in radiology. 

Legal Medicine Symposium 14-16 Nov 1978 

This course is designed to consider the legal problems developing in 
the practice of medicine. Risk management and liability control will 
be emphasized. Systems, organizational structures and accountabili- 
ties will also be considered. Programs of prevention, aimed at re- 
ducing frequency and severity of hospital and medically related in- 
juries, will be demonstrated by case illustrations. The various 
presentations are primarily intended to orient hospital administra- 
tive, medical, legal, and health insurance personnel to the need for 
more intensive procedures and controls to eliminate injuries and in- 
cidents. 



Applicants should be assigned to a medical or legal 
facility or organization within the federal services. Fed- 
eral hospital senior medical personnel or claims inves- 
tigators are especially invited. Applications from other 
qualified personnel will be considered on a space- 
available basis. 

Basic Forensic Pathology 27 Nov-1 Dec 1978 

This course is designed to provide basic training in the special field of 
forensic pathology, as a supplement to military and civilian residency 
training programs in pathology. Emphasis is placed on the applica- 
tion of scientific methods to untoward effects of the interaction of man 
and his environment. The material for this course is presented by 
specialists in the fields of forensic sciences, law, and investigation 
through illustrated slide lectures and demonstrations. 

Applicants should be resident pathologists, or path- 
ologists in the Medical Corps of the Armed Forces or 
the federal services. Civilian pathologists, including 
residents, may apply and be considered on a space- 
available basis. 

Further information may be obtained by writing to 
the Director, Armed Forces Institute of Pathology, 
ATTN: AF1P-EDZ, Washington, D.C. 20306. 

Patient services training course ... As a result of in- 
creasing needs and demands of the Medical Depart- 
ment patient services community, a new course of in- 
struction has been established by BUMED to train 
qualified officers for entry-level positions in Patient 
Services Administration. The curriculum for this pro- 
gram covers medical-records administration, alterna- 
tive health benefits programs and beneficiaries, quan- 
titative analysis in the health field, auditing and quality 
assurance, patient disposition, decedent affairs, and 
organizational behavior. 

The five-week program will be conducted at the 
Naval School of Health Sciences, Bethesda, Md., with 
the first class of 15 Medical Service Corps officers 
scheduled to convene on 10 Oct 1978. 

Navy cocktail party at ACS meeting ... In conjunction 
with the American College of Surgeons meeting in San 
Francisco, Calif., there will be a Navy cocktail party 
held on Wednesday evening, 18 Oct 1978, from 6:30 to 
9:30, at the Marines' Memorial Club, 609 Sutter Street, 
San Francisco. For more information contact: CAPT 
R.M. Deaner, MC, USN, Chairman, Department of 
Surgery, Naval Regional Medical Center, Oakland, 
Calif. 94627. 



U.S. Navy Medicine 



American board certifications 

indicated in parentheses): 



American Board of Anesthesiology 
LCDR Robert E. Woodruff, MC, USNR 
LT Richard H. Balzer, MC, USNR 



American Board of Dermatology 
CDR Kenneth G. Gross, MC, USNR 
LCDR Lauren A. Daman, MC, USNR 
LCDR Stephen W. Shewmake, MC, USN 

American Board of Endodontics 
CAPT Arthur E. Krzeminski, DC, USN 
CDR George S. Foster, DC, USN 

American Board of Family Practice 
CDR William D. Craver, MC, USN 
LCDR Thomas W. Coale, MC, USNR 
LCDR Rafael K. Deramos, MC, USNR 
LCDR Richard L. Harman, MC, USN 
LCDR Robert W. Harrison, Jr., MC, USN 
LCDR Mark Jacobs, MC, USN 
LCDR Oliver K. Williams III, MC, USNR 
LCDR George R. Wilson III, MC, USNR 
LCDR James W. Wilson, MC, USNR 
LT Warren T. Wilson, MC, USNR 

American Board of Internal Medicine 

CDR Richard G. Daly, MC, USN (Endocrinology and 
Metabolism) 

CDR George A. Luiken, MC, USNR (Medical Oncology) 

CDR Stanley I. Thompson, MC, USNR (Cardiovascular 
Disease) 

LCDR Theodore W. Burns, MC, USNR (Gastroenter- 
ology) 

LCDR George R. Freeland, MC, USN (Gastroenter- 
ology) 

American Board of Ophthalmology 
LCDR Warren L. Broughton, MC, USNR 
LCDR Gregory W. Cobb, MC, USNR 
LCDR Thomas O. Morris, MC, USNR 
LT Fredric D. Young, MC, USNR 

American Board of Oral and Maxillofacial Surgery 

CDR Roger E. Alexander, DC, USN 

LCDR Kenneth J. Davis, DC, USN 

LCDR Harvard J. Van Belois, Jr., DC, USN 

LCDR Robert J. Vosskuhler, DC, USN 



(Subspecialties are American Board of Pediatrics 

LCDR Charles B. Brett, MC, USN 
LCDR Johnny H. Dalton, MC, USN 
LCDR Stephen M. Golden, MC, 

Perinatal Medicine) 
LCDR Ulf R. Hierlwimmer, MC, USNR 
LCDR John E. Wimmer, Jr., MC, USNR (Neonatal- 
Perinatal Medicine) 



USNR (Neonatal- 



American Board of Periodontology 
CDR Dennis R. Ahl, DC, USN 
CDR Charles H. Julienne, DC, USN 
LCDR Richard R. Gartner, Jr., DC, USN 
LCDR James T. Mellonig, DC, USN 

American Board of Prosthodontics 
CAPT Charles M. Johnson, DC, USN 
CDR Edward J. Billy, DC, USN 
CDR Mark E. Heilman, DC, USN 
CDR Robert W. Hinman, DC, USN 
LCDR Thomas A. Lynde, DC, USN 

American Board of Surgery 
CDR Edsel J. Aucoin, MC, USN 
LCDR Martin S. Barber, MC, USN 
LCDR Mitchell H. Goldman, MC, USNR 
LCDR William R. Rowley, MC, USNR 
LCDR John J. Stoltenberg, MC, USNR 
LCDR Michael A. Watts, MC, USN 

American Board of Urology 

CDR George J. Gavrell, MC, USN 

CDR Raza M. Khan, MC, USN 

CDR Gordon R. MacDonald, Jr., MC, USNR 

LCDR Jeffrey H. Kossow, MC, USNR 

LCDR Donald E. Sawyer, MC, USNR 

American Academy of Microbiology 
CAPT Sam W. Joseph, MSC, USN 

Army Board of General Dentistry* 
CAPT James V. Gourley, DC, USN 
CAPT Ronald K. Harris, DC, USN 
CAPT John T. Stevens, DC, USN 
CDR Richard B, Finger, Jr., DC, USN 
CDR Glenn E. Gordon, DC, USN 
CDR Dean D. Schloyer, DC, USN 
CDR Gary W. Troutman, DC, USN 

♦Recognition applicable to military services only 



Volume 69, September 1978 



Scholars' Scuttlebutt 



The Medical School Liaison Officer 



The complex nature of the Armed 
Forces Health Professions Scholar- 
ship Program places a high premi- 
um on the development of effective 
communication links with students 
in the field. While the overall re- 
sponsibility for this task rests with 
the Surgeon General of the Navy, he 
is ably assisted by a cadre of inac- 
tive Reserve officers who serve as 
Medical School Liaison Officers at 
medical and osteopathic schools 
throughout the United States. 

Officers assigned to duty as Med- 
ical School Liaison Officers are re- 
cruited from among inactive Re- 
serve officers of the Navy Medical 
Department who hold faculty or 
administrative appointments at 
their respective schools. Officers 
assigned to MSLO duties serve in 
addition to their primary assign- 
ments with Naval Reserve Units. 
While so assigned, Medical School 
Liaison Officers perform the follow- 
ing duties: 

• Act as the designated repre- 
sentative of the Surgeon General of 
the Navy at the medical school for 
all matters pertaining to the Armed 
Forces Health Professions Scholar- 
ship Program. 

• Maintain liaison with the Com- 
manding Officer, Naval Health Sci- 
ences Education and Training Com- 
mand, on routine matters pertain- 
ing to administration of the Armed 
Forces Health Professions Scholar- 
ship Program. 



• Disseminate to Navy scholar- 
ship students, on a regular basis, all 
pertinent information, directives, 
and other guidance from higher 
authority. 

• Remain responsive to the mili- 
tary needs of scholarship students 
and assist, where required, in all 
communications between students 
and higher authority via the chain of 
command. 

• Provide a point of contact for 
representatives of the Commander, 
Naval Recruiting Command, in all 
matters relating to the recruiting of 
prospective applicants for the 
Armed Forces Health Professions 
Scholarship Program. Assist, when 
requested, in promoting physician 
direct appointment recruiting. 

At press time, the following offi- 
cers of the Navy Medical Depart- 
ment were serving as Medical 
School Liaison Officers for their 
respective schools: 

REGION ONE 

DARTMOUTH 

CAPT Walter C. Griggs, MC, USNR-R 

HARVARD 

CDR George Gifford, MC, USNR-R 

U. OF MASSACHUSETTS 

CAPT Charles I. Brink II, MC, USNR-R 

TUFTS 

CDR Bradley E. Brownlow, MC, USNR-R 

U. OF CONNECTICUT 

CDR John Haney, MC, USNR-R 

BROWN 

LCDR James P. Crowley, MC, USNR-R 



YALE 

LT Joel Labow, MC, USNR-R 



REGION TWO 

U. OF VERMONT 

CAPT Thomas R. Kleh, MC, USNR-R 

ALBANY MEDICAL 

LCDR W.J. Paladine, MC, USNR-R 

CORNELL 

LCDR Carl Bersten, MC, USNR (Ret.) 

NEW YORK MEDICAL 

CAPT Kirk K. Kazarian, MC, USNR-R 

SUNY AT BROOKLYN 

CDR Sheldon Bleicher, MC, USNR-R 



REGION FOUR 

JEFFERSON MEDICAL 
CDR Joseph W. Sokolowski, Jr., MC, 
USNR-R 

MEDICAL OF PENNSYLVANIA 
CDR Frank I. Marlowe, MC, USNR-R 

PENNSYLVANIA STATE 

CDR Robert C. Knowles, MC, USNR-R 

U. OF PENNSYLVANIA 

RADM-Selectee John R, Senior, MC, 
USNR-R 

TEMPLE 

CDR George E. Ehrlich, MC, USNR-R 

RUTGERS 

CAPT Frederic F. Primich, MC, USNR-R 

NEW JERSEY COLLEGE OF MEDICINE & 

DENTISTRY 

CDR Norman Ende, MC, USNR-R 

REGION FIVE 

CASE WESTERN RESERVE 

CAPT Alfred D. Heggie, MC, USNR-R 

U. OF CINCINNATI 

CAPT Thomas H. Joyce, MC, USNR-R 



U.S. Navy Medicine 



REGION SIX 

GEORGETOWN U. 
CAPT Herbert G. Hopwood, Jr., MC, 
USNR-R 

HOWARD U. 

CAPT Sherman Ross, MSC, USNR-R 

JOHNS HOPKINS U. 

CAPT Gardner W. Smith, MC, USNR-R 

MARSHALL U. 

CAPT George J. Hill, MC, USNR-R 

EASTERN VIRGINIA MEDICAL SCHOOL 
HMCS E.J. Morrison (Ph.D), USNR-R 

U. OF VIRGINIA 

CAPT Lockhart B. McGuire, MC, USNR-R 

REGION SEVEN 

BOWMAN GRAY 

CAPT John D. Tolmie, MC, USNR-R 

U. OF NORTH CAROLINA 

CDR D.E. Widmann, MC, USNR-R 

U. OF SOUTH CAROLINA 

CDR Frank N. Boensch, MC, USNR-R 

CDR Wilson B. Rumble, MC, USNR-R 

REGION EIGHT 

MEDICAL OF GEORGIA 

CAPT H. Turner Edmondson, MC, USNR-R 

U. OF FLORIDA 

CDR James J. Cerda, MC, USNR-R 

U. OF MIAMI 

CDR Ronald J. Hagan, MC, USNR-R 

U. OF SOUTH FLORIDA 

CDR James N. Endicott, MC, USNR-R 

U. OF KENTUCKY 

CDR Jesse Harris, MC, USNR-R 

U. OF LOUISVILLE 

CAPT Richard F. Greathouse, MC, USNR-R 

MEHARRY COLLEGE 

CAPT Emerson Emory, MC, USNR-R 

U. OF TENNESSEE 

CAPT Joseph H. Miller, MC, USNR-R 

VANDERBILT 

CAPT Raphael F. Smith, MC, USNR-R 

U. OF ALABAMA 

CAPT Charles E. Herlihy, MC, USNR-R 

U. OF SO. ALABAMA 

CAPT Leland Edmonds II, MC, USNR-R 



U. OF MISSISSIPPI 

CAPT Frank J. Morgan, MC, USNR-R 

REGION TEN 

LOUISIANA STATE U. AT NEW ORLEANS 
CAPT Roy H. Barnes, MC, USNR-R 

LOUISIANA STATE U. AT SHREVEPORT 
CAPT Norman L. Mauroner, MC, USNR-R 

TULANE 

CDR William A. Martin, MC, USNR-R 

U. OF ARKANSAS 

CDR Jerry L. Thomas, MC, USNR-R 

BAYLOR 

CAPT Paul B. Radelat, MC, USNR-R 

U. OF TEXAS AT GALVESTON 
CDR Daniel L. Creson, MC, USNR-R 

REGION ELEVEN 

TEXAS TECH 

CAPT Joseph R. Sasano, Jr., MC, USNR-R 

U. OF OKLAHOMA 

CDR Lawrence D. Amick, MC, USNR-R 

MICHIGAN STATE 

CDR James Jackson, MC, USNR-R 

U. OF MICHIGAN 

RADM Park W. Willis, MC, USNR-R 

INDIANA U. 

LCDR John M. Doty, MSC, USNR-R 

U. OF CHICAGO 

CDR Stanton Polin, MC, USNR-R 

LOYOLA 

CAPT William Ertl, MC, USNR-R 

CDR Mario D. Oriatti, MC, USNR-R 

NORTHWESTERN 

LCDR John K. Hurley, MC, USNR-R 

U. OF WISCONSIN 

CDR Thomas D. France, MC, USNR-R 



REGION SIXTEEN 

U. OF IOWA 

CAPT Peter R. Jochimsen, MC, USNR-R 

MAYO MEDICAL 

CAPT Harry Bisel, MC, USNR-R 

U. OF MINNESOTA AT MINNEAPOLIS 
CAPT Richard Woellner, MC, USNR-R 

U. OF SOUTH DAKOTA 

CDR James K. Jackson, MC, USNR-R 



REGION EIGHTEEN 

U. OF MISSOURI AT COLUMBIA 
CDR William C. Allen, MC, USNR-R 

SAINT LOUIS U. 

RADM Matthias Backer, Jr., MC, USNR-R 

U. OF KANSAS CITY 

CDR James H. Chapman, MC, USNR-R 

U. OF NEBRASKA 

CDR Wm M. Berton, MC, USNR-R 

U. OF COLORADO 

RADM Ben Eiseman, MC, USNR-R 

REGION NINETEEN 

U. OF ARIZONA 

CAPT James A. Austin, MC, USNR-R 

CAPT George H. Mertz, MC, USNR-R 

U. OF CALIFORNIA AT IRVINE 
CDR Glenn W. Fowler, MC, USNR-R 

U. OF CALIFORNIA AT LOS ANGELES 
CAPT Harry T. Wright, Jr., MC, USNR-R 

U. OF CALIFORNIA AT SAN DIEGO 
CDR Kenneth M. Moser, MC, USNR-R 

U. OF SO. CALIFORNIA 

CAPT James T. Helsper, MC, USNR-R 

CAPT Harry T. Wright, Jr., MC, USNR-R 

REGION TWENTY 

U. OF UTAH 

LCDR William C. Vincent, MC, USNR-R 

U. OF CALIFORNIA AT DAVIS 
CAPT Walter A. Tatge, MC, USNR-R 

U. OF CALIFORNIA AT SAN FRANCISCO 
CAPT Richard J. Bartlett, MC, USNR-R 

STANFORD 

CAPT Franklin G. Ebaugh, MC, USNR-R 

REGION TWENTY-TWO 

U. OF OREGON 

CAPT Richard M. Bernard, MC, USNR-R 

U. OF WASHINGTON 

CDR James R. Hooley, DC, USNR-R 

SCHOOLS OF OSTEOPATHIC MEDICINE 

KANSAS CITY COLLEGE 

LCDR James H. Chapman, MC, USNR-R 

MICHIGAN STATE 

LCDR John R. Downs, MC, USNR-R 

KIRKSVILLE COLLEGE 

CAPT James J. Woodruff, MC, USNR-R 



Volume 69, September 1978 



Instructions & Directives 



New Hospital Corpsman specialty established 

In May 1974, BUMED approved the formal training of Ocular Technicians, and BUPERS ap- 
proved the assignment of the NEC HM-8444 for this training. It was planned at that time that 
the training of Advanced Ocular Technicians would be approved at such time as the manning 
in NEC HM-8444 permitted. This manning has been attained, and BUMED has approved the 
training of Advanced Ocular Technicians through on-the-job training (OJT). BUPERS has 
approved assignment of the NEC HM-8445. 

The following activities have been approved for establishment of an OJT Program for Ad- 
vanced Ocular Technician, HM-8445: 

• CO, NATNAVMEDCEN, Bethesda, Md. 

• CO, NAVREGMEDCEN, San Diego, Calif. 

• CO, NAVREGMEDCEN, Portsmouth, Va. 

• CO, NAVREGMEDCEN, Oakland, Calif. 

Designation of billets and realignment have been accomplished at headquarters level, effec- 
tive April 1978. 

Commanding officers should provide widest possible dissemination of the information and 
changes included herein. 

A number of NEC change recommendations have been received by BUMED, certifying 
completion of OJT in advanced ocular technique. Each request will be evaluated to ensure that 
the training received is officially recognized. 

Commands that have HM-8445 requirements but are not authorized to conduct OJT will 
have their requirements met by normal sea/shore rotation as qualified personnel become 
available. 

All OJT in NEC HM-8445 initiated after 1 July 1978 must be in compliance with BUMED- 
INST 1510. 10D.— BUMED Notice 1510 of 27 June 1978. 



Mercury vapor hazard 

The purpose of this notice is to provide a method for eliminating the mercury vapor hazard in 
dental operating rooms that utilize the Denta-Vac air-operated vacuum system manufactured 
by A-dec, Inc., 2601 Crestview Drive, Newberg, Ore. This device is used to remove debris, 
saliva, amalgam scraps, etc., from the patient's mouth while dental procedures are being per- 
formed. 

Enclosure (1) of this notice provides detailed instructions for modifying the Denta-Vac to 
prevent mercury vapor from being exhausted to the environment. 

All Denta-Vacs presently installed in dental operating rooms aboard ships and at dental 
clinics ashore should be modified. Without this modification, the Denta-Vac will exhaust 
mercury vapors into the dental operatory. — BUMED Notice 6260 of 9 May 1978. 



Transfer of health records to NPRC, St. Louis 

Because of numerous reports of discrepancies in record-transfer procedures received by the 
National Archives and Records Service, GSA, OPNAV has requested BUMED to direct correc- 
tive action. 

10 U.S. Navy Medicine 



In terms of the number of reports received, the Medical Department is one of the largest 
offenders, compared with other Navy activities, in not following correct procedures for trans- 
ferring health care treatment records to the National Personnel Records Center (NPRC) at St. 
Louis, Mo. The following discrepancies are most frequently cited: 

• Records intermix. Inpatient, outpatient, and emergency room treatment records of mili- 
tary personnel and dependents have not been separated and are being shipped intermixed. 
requiring the records of dependents and other supernumerary patients to be retained at NPRC 
unnecessarily for 25 years beyond the normal disposal date. 

• SF 135, Records Transmittal and Receipt. Advance notice copy not sent to NPRC at least 2 
weeks prior to shipping data; obsolete SF 135 used; form not signed; required number of 
copies not sent; description of records and years covered not entered on form; disposal author- 
ity cited incorrectly or not cited; etc. 

• Other. Standard shipping cartons not used; nominal (name) index to records not included 
in shipment; records shipped to wrong address. 

A properly conducted records disposition program is an essential function in the administra- 
tion and cost-effective management of naval health care facilities. Local programs interface 
with and directly affect the NPRC in maintaining an automated inventory system, storing 
records, and providing prompt retrieval service. Medical Department records have a 
long-term value to patients and are vital to protecting the interest of the Government. 

Each discrepancy in the transfer of health care treatment records to NPRC results in delay 
and a preventable loss of resources by the Medical Department. The National Archives and 
Records Service, GSA, has advised that unless the deficiencies in records shipments received 
from naval activities are corrected, NPRC will be directed to refuse acceptance. Records 
shipped to NPRC with major deficiencies will be returned at Medical Department expense. 

Effective immediately, ships and stations having medical personnel shall fully comply with 
the detailed instructions on record transfer provided as enclosure (1) of this notice. — BUMED 
Notice 5212 of 29 June 1978. 



Yellow fever vaccine 

Since 3 Jan 1978, the yellow fever vaccine previously produced and distributed by Merrell- 
National Laboratories, Inc., has been manufactured by Connaught Laboratories, Inc., Swift- 
water, Pa. 18370, and is being distributed by Elkins-Sinn, Inc., 2 Esterbrook Lane, Cherry 
Hill, N.J. 08002. After 28 Feb 1978, Merrell-National was to cease all distribution; however, 
because the expiration date of their vaccine is 28 Feb 1979, it may be available for administra- 
tion through that date. 

International certificates of vaccination against yellow fever before 28 Feb 1979 may list 
either Merrell-National or Connaught under the heading "manufacturer," depending upon 
the brand of vaccine administered. Certificates completed after 28 Feb 1979 must list Con- 
naught as manufacturer; otherwise, the certificate is invalid and the traveler may have to be 
revaccinated before entering those countries that require a valid certificate.— BUMED Notice 
6230 of 18 April 1978. 

Volume 69, September 1978 11 



In good times and in lean ones, a 'can do' spirit 
has been the program's hallmark 

Naval Aviation Physiology 

LCDR Terrence J. O'Leary, MSC, USN 



During World War I — because the primary role of 
naval aviation was antisubmarine warfare — most 
Navy flying was done at low speed and low alti- 
tude. As a result, there was little or no appreciation of 
the stresses of high-altitude flight. 

By the end of the war, however, aircraft were avail- 
able that could attain an altitude of 25,000 feet. As 
higher flights became more routine, the need for a sup- 
plemental oxygen supply for pilots became apparent. 

In 1927, a letter from the Chief of the Bureau of 
Aeronautics indicated that 2,000 oxygen tanks that had 
been purchased by the Navy in 1922 (probably for 
welding purposes) could be used for aviation. (At that 
time, oxygen was supplied to the aviator through a 
pipestem hooked over his lip.) 

In 1929, a memorandum endorsement from the 
Director of Fleet Training to the Chief of Naval Oper- 
ations emphasized the importance of supplemental 
oxygen for high-flying pilots (/): 

It is apparent that the use of oxygen at altitudes of 15,000 to 16,000 
feet is not necessary for safety but is extremely desirable in that the 
physical and mental capability of the pilot is increased. Above these 
altitudes, the necessity for oxygen increases and the factor of safety 
to personnel enters. 

In February 1940 — with prewar naval activities on 
the increase — the Medical Research Section of the 
Bureau of Aeronautics recommended that facilities be 
procured to provide oxygen indoctrination for all flying 
personnel. Through lectures and training films, in- 
struction was to be given on the effects of "anoxia" 
(lack of oxygen) at altitude, and on the use of oxygen 
equipment. Practical demonstrations were to be pro- 
vided in low pressure chambers, where flight personnel 
could experience firsthand the consequences of anoxia 
and the benefits of supplemental oxygen. 



In July of the same year, the Bureau of Aeronautics 
approved installation of low pressure chambers at the 
basic flight training schools at Pensacola, Corpus 
Christi, Miami, and Jacksonville. 

In May 1941, LT H. J. Rickard, MC, USNR, LT T. D. 
Boaz, MC, USN, Pharmacist's Mate First Class H. G. 
Leak, and Water Tender First Class J. Krohn were or- 
dered by the Bureau of Navigation to proceed to the 
Navy Department in Washington for two weeks' train- 
ing as members of the Navy's first Altitude Training 
Unit (2). 

This group spent the first week with the Experi- 
mental Diving Unit at the Washington Navy Yard, 
where there was a low pressure chamber, used primar- 
ily for research and development, and staffed by quali- 
fied divers. The group's second week was spent in 
Boston at the Harvard School of Public Health, which 
also had a low pressure chamber and was already train- 
ing two Army flight surgeons in high-altitude 
problems. 

By June the four were in Pensacola, where they gave 
a two-week course of instruction to prospective train- 
ing-unit personnel from the other basic flight schools 
and began the training of cadets. 

Of the early altitude instructors, Williams and Barr 
(3) wrote: 

One of the major accomplishments of the . . . program during 1941 
and 1942 was to dispel misconceptions concerning the use of oxygen. 
It was commonly believed that breathing 100 percent oxygen was 
harmful, that strong men did not need supplemental oxygen until 
they reached comparatively high altitudes, and that only the 



LCDR O'Leary is a naval aviation physiologist assigned to the 
NNMC Branch Clinic, Washington, D.C., with additional duty to the 
1099th Physiological Training Flight, Malcolm Grow USAF Medical 
Center, Andrews AFB, Md. 20031. 



Volume 69, September 1978 



13 



physically weak needed to use oxygen at low altitudes. To many, use 
of oxygen at low altitudes was an admission of weakness and lack of 
stamina. These misconceptions were so prevalent and firmly in- 
grained that altitude training personnel soon found themselves sell- 
ing the use of oxygen to aviation personnel. 

Demonstrations were given in low pressure cham- 
bers like the one at Pensacola, described by Boaz (4): 

The chamber, which is cylindrical in shape, is 20 feet long, 8 feet in 
diameter, and is divided into 2 compartments; the larger is 16 feet 
long, containing 14 seats (7 along each side), and the smaller or lock 
compartment being merely 4 feet long and containing 2 seats on each 
side. The 2 compartments may be operated separately when the door 
between them is secured. This is of importance for individuals who 
become distressed during a simulated high-altitude run. They may be 
transferred to the lock compartment and brought quickly to atmos- 
pheric pressure while the others remain at the simulated high altitude 
and complete the "flight," 

By late 1941, the four low pressure chambers origi- 
nally ordered had become so overworked that six more 
were procured for other air stations. (For oxygen train- 
ing in fleet units, six mobile chambers were procured in 
1943.) 

In November 1941, wrote Williams and Barr (3): 

. . . plans were developed for a program of pilot declassification based 
on each aviator's tolerance to anoxia, chilling, and air embolism . . . 
During 1942 the Altitude Training Unit at Pensacola conducted in- 
vestigations aimed at the establishment of measures of altitude toler- 
ance. Reactions to hypoxia at altitudes of 18,000 and 18,500 feet were 
studied . . . Installation of the first refrigerated low pressure chamber 
was completed at Pensacola in December 1942. 

Cadets had to demonstrate a tolerance for tempera- 
tures as low as -30 q F while at a simulated altitude of 
30,000 feet. Those showing lesser tolerances were lim- 
ited to flying low-altitude aircraft. 

A course of instruction in low pressure chamber 
technology, leading to the designation "low pressure 
chamber technician," was established in 1941 for hos- 
pital corpsmen (pharmacist's mates), and Altitude 
Training Units began giving the course in 1942. In 
December 1943, the first classes of WAVE corpsmen 
began this training, so they could replace male corps- 
men needed for fleet assignments. 



Pollard (5) wrote that there were 10 medical officers 
trained at Pensacola in 1942 "as instructors to in- 
augurate low pressure chamber training at their 
respective duty stations. Also., H-V(S) officers were 
trained as instructors." 

"H-V(S)," for "Hospital Corps-Volunteer (Special- 
ist)," was a designation given to certain officer special- 
ists brought into the Navy in World War II. These 





If 


^^^fc 








Plr 


■y^ 5 .▼ JM 


^^^^r*w**\ 


^^^^^ s ^PSi^fc^ 


\^y*^ 


ml ijjKJ 



Aviation cadets at work in NAS Pensacola's refrigerated 
low-pressure chamber, installed in December 1942. 



H-V(S) officers were the predecessors of Medical Ser- 
vice Corps aviation physiologists. At the time, however, 
they were designated "environmental physiologists." 

Ensigns Wilson C. Grant, Arthur H. Smith, and 
Daniel T. Watts formed the first class of physiologists 
to receive altitude training, 

ENS Smith arrived at Pensacola in April 1942, a 
month early for training, and was temporarily assigned 
to work with LT Peckham, an aviation psychologist who 
was developing a night vision training program. 

Of his subsequent altitude indoctrination, Smith 
says, "Nobody talked to us — we just learned by OJT." 
Not until two or three classes later was a formal curric- 
ulum established. 

In December of that year, Smith was transferred to 
MCAS Cherry Point, N.C., to establish an Altitude 
Training Unit there. Subsequently he was assigned to 
NAS Jacksonville, then to MCAS Santa Barbara, where 
he served as the night vision training officer until 
February 1946. 

For Grant there are some vivid memories of Pensa- 
cola in 1942. 

One is of the visit of First Lady Eleanor Roosevelt, 
who arrived during an inspection tour to learn where 
women might fit into the Navy training program. 
While at Pensacola she went through a low pressure 



14 



U.S. Navy Medicine 



chamber flight on which ENS Grant was an observer. 
The original intention was to take Mrs. Roosevelt on a 
"flight" to only a few thousand feet; however, despite 
lengthy explanations of potential discomforts, she in- 
sisted on sharing the experience of the student pilots. 

Another memory is an unhappy one, for Grant was a 
witness to the plane crash in which CDR Eric Liljen- 
crantz— the Navy's first flight surgeon to die in an air- 
craft accident — was killed. Grant had been flying in the 
same aircraft on the flight just before the fatal accident. 

After leaving Pensacola in December 1942, ENS 
Grant served in the Altitude Training Unit at NAS 
Norfolk for three or four months before becoming a line 
officer. Eventually, he switched to PT boats, arriving in 
the Philippines just as the war ended. 

The third classmate, ENS Watts, had joined the Navy 
as a line officer, in his rush to enter the war effort. After 
three months' active duty at Key West, he became an 
H-V(S) officer and was ordered to Pensacola in May 
1942 for altitude training. 

After a subsequent tour at NAS Alameda, he served 
from early 1944 until 1947 at the Naval Air Experi- 
mental Station, Philadelphia, carrying out some of the 
early human-factors research leading to development of 
the first Navy ejection seat. Two special visitors to the 
station during that time were Charles Lindbergh and 
James Doolittle, whom Watts laconically describes as 
' ' characters — e specially Doolittle . " 

Early in 1943, NAS Jacksonville's Altitude Training 
Unit established a course of instruction leading to 
the designation "oxygen officer." A few of the 
students were physiologists, but most were pilots who 
had been disqualified from flying, cadets who had not 
completed flight training, and others. 

Since at the time there was no such thing as a test 
stand to check oxygen equipment, these people were 
tasked with checking each pilot's equipment prior to 
flight— and occasionally at altitude in an aircraft. They 
were often assigned to an Altitude Training Unit; how- 
ever, they spent most of their time with the squadrons. 

Later, air-sea rescue and survival training was added 
to the "oxygen officer" course, and the designation for 
graduates was changed to "aviation equipment and 
survival officer." A school similar to Jacksonville's was 
established at Pensacola in 1944, and by the end of 1945 
the two schools had trained more than 400 officers (3), 

By 1943, rapid expansion of the aviation training and 
pilot declassification program had begun making it 
difficult for Altitude Training Units to comply with the 
numerous directives they were receiving. Shortages of 
trained medical personnel were occurring. Moreover, 
ground- and flight-training syllabuses for cadets were 
too crowded to allow enough time for the oxygen indoc- 
trination courses and altitude classifications requested 
by the Bureau of Aeronautics. In short, the program 
was becoming a major administrative problem. 

In April 1943, the Bureau of Aeronautics asked 



BUMED to assume responsibility for the program, and 
within a few months altitude training had become the 
program's primary mission (J). 

Describing developments during this period, Pollard 
(5) wrote: 

The Bureau of Medicine and Surgery established a Low Pressure 
Chamber and Oxygen Section under its Division of Aviation Medicine 
in June 1943 and subsequently administered the development of 
training techniques, the conduct of high altitude training for the 
training commands and the fleet, and provided trained instructors 
and supervisory personnel. The conduct of the training at the local 
level was placed under the direct supervision of the local senior 
medical officer. Assistance was obtained from locally assigned junior 
flight surgeons. 

It should be noted that early in the program not all 
Altitude Training Units had physiologists assigned. In 
those that did, a flight surgeon was still directly in 
charge, and the physiologist served as his assistant. 

With the war at an end, the training of corpsmen as 
low pressure chamber technicians was discon- 
tinued in late 1945. 

Summer 1946 saw a massive exodus of personnel 
and, wrote Pollard (5), "aviation physiology training 
collapsed due to the release of trained instructors from 
active duty." 

But progress in the science of aeronautics— and the 
advent of more sophisticated aircraft — assured that the 
setback would be only temporary. 

By this time the Navy was developing ejection seats 
for its high-performance aircraft, and on 30 Oct 1946 
former ENS Daniel T. Watts— by then a lieutenant 
commander — was witness to the first live Navy ejection 
from an airborne platform. 

The aircraft was a JD-1, and the volunteer was LTJG 
A. J. Furtek, who had been a qualified parachutist as 
an enlisted man and had later become a naval aviator. 

The ejection process was supposed to work like this: 
After ejection had been initiated, a static line, attached 
to the aircraft, was to open the main parachute, which 
was attached to the ejection seat. When descent of the 
seat had been slowed down, the occupant was to dis- 
connect himself, fall away from the seat, and open his 
personal parachute. 

After five perfect dummy trials, it was decided to try 
a live firing. With the aircraft at about 10,000 feet, 
flying at about 205 mph, Furtek began his ejection; 
however, the main parachute failed to open completely. 
To observers, Furtek seemed slow in getting out of the 
seat, but he finally pushed himself out at about 1,500 
feet above ground. He fell some 200 feet more before 
getting his parachute open and landing safely. 



u 



ntil the establishment of the Allied Science Branch 
of the Medical Service Corps in 1948, there was no 
established career pattern in the Navy to attract 



Volume 69, September 1978 



15 




At Pensacola, WAVES teach aviation cadets proper use of oxygen equipment (1943). 



aviation physiologists," Pollard (5) wrote. He noted 
that although flight surgeons tried to conduct aviation 
physiology training, there were too few of them to do so 
adequately. Thus, "the unavailability of instructors 
was an important factor in the slow revitalization of 
training." 

At the 1948 Naval Air Training Command Confer- 
ence, according to Pollard, a "general strengthening of 
the training was recommended, including the addition 
of regularly scheduled refresher training for fleet 
pilots." Still, the end of 1950 saw just four aviation 
physiologists on active duty. 

LT Elizabeth Reeves, stationed at North Island, was 
the only physiologist who had come on board during 
World War II and had remained on continuous active 
duty. LTs Glenna Cahill, stationed at Jacksonville, and 
Mary F. Keener, at Norfolk, had been asked to return 
to active duty to help revitalize the program. CDR 



Roland A. Bosee, at El Centro, had been a naval aviator 
during World War II and had converted to aviation 
physiology in 1947. 

In early 1951, a 10-week course was conducted for the 
first class of student "applied aviation physiologists" 
in six years. The five graduates were LTJG Bill Archer, 
assigned to Philadelphia; LTJG Kenneth Coburn, to 
Pensacola; LTJG Tom Ferris, to Atlantic City; ENS 
Harold Bower, to North Island; and ENS Morris 
Damato, to Corpus Christi. 

In March of that same year, BUMED accepted the 
Navy's first portable ejection seat tower designed 
exclusively for training purposes. The prototype was 
installed at NAS North Island for evaluation by the 
Altitude Training Unit, with LCDR Marvin Courtney 
(MC), a flight surgeon, as project officer. Shortly 
thereafter, ejection seat trainers were installed at all 
training unit locations. 



16 



U.S. Navy Medicine 



The first female aviation physiologist to enter the 
program after World War II was ENS Nancy Murtagh, 
who completed her training in fall 1951 and was as- 
signed to NAS Alameda. She says she initiated the 
push for hazardous duty incentive pay (HDIP) for 
officers and enlisted personnel routinely making low 
pressure flights, having begun her work on the HDIP 
proposal around 1953. 

In June 1954, a bill introduced in the Senate included 
the statement that "duty as low-pressure chamber 
inside instructor" entitled individuals assigned by 
competent authority to HDIP. The resulting Career 
Incentive Act of 1955 set the monthly HDIP for officers 
at $110; for enlisted personnel at $55. 

In early 1959, the Hospital Corps NEC of 8409 was 
established for low pressure chamber technicians. 
These individuals had to be qualified aviation medicine 
technicians (AVTs) who had received on-the-job train- 
ing with Altitude Training Units. (Around 1962, a for- 
mal low pressure chamber technician course was 
established for selected volunteers, and in 1963 the 
designation for these individuals was changed to 
"aviation physiology technician.") 



In 1961 an ADDU billet— Head, Aviation Physi- 
ology Branch— was established at BUMED, and 
CAPT Mary F. Keener was appointed to Fill it. 
(The billet became full-time in 1965 but was lost in 1976 
because of personnel cuts following the Vietnam 
conflict.) 

Late in 1962, LCDR Harold Bower presented a pro- 
posal to CAPT Clifford Phoebus, Commanding Officer 
of the Naval Aerospace Medical Institute, Pensacola, 
concerning the training of naval aviation physiologists. 
Under the proposal, preflight and flight training would 
be added to the curriculum — a measure that would 
lengthen the course from ten weeks to nearly six 
months. Also, naval aviation physiologists would be- 
come designated aircrew members, rating flight pay 
and the right to wear wings. The purpose of the pro- 
posal was to ensure that the training physiologists pro- 
vided would be oriented, not just to the low pressure 
chamber, but to the real world of aviation. 

In January 1963, LCDR Bower and CAPT Phoebus 
presented the proposal at BUMED to CAPT Keener; 
CAPT Merrill H. Goodwin, Assistant Chief for Aviation 
Medicine; and CAPT Robert S. Herrman, Chief of the 
Medical Service Corps — all of whom liked the idea. 

In December 1965, LT Durward Rhoades, ENS Tom 
Bird, and ENS Robert L. Smith became the first 
aviation physiologists to complete the new flight-train- 
ing syllabus. On 10 Jan 1966, the Secretary of the Navy 
approved the designation of naval aviation physiolo- 
gists as aircrew members. And on 12 April 1967, a 
change in the U.S. Navy Uniform Regulations per- 
mitted wearing of wings by designated naval aviation 
physiologists. 



Early in 1970, CDR Paul W. Scrimshaw— who had 
relieved CAPT Keener at BUMED — called a meeting of 
some of the senior aviation physiologists to standardize 
Navy physiology training procedures and syllabuses. 
The resulting changes went into effect in fall 1970 and 
included expansion of the night vision lecture to cover 
various aspects of visual problems, vertigo, and disori- 
entation. Added to the oxygen equipment lecture was a 
briefing on all pertinent items of aircrew protective and 
survival equipment. 

In January 1975, LCDR David G. Smith (MSC) en- 
tered the Aviation Safety Officers School at Monterey, 
becoming the first of a growing number of naval 
aviation physiologists in the Aeromedical Safety Oper- 
ations (AMSO) program. Awareness of the need for 
more emphasis on the medical aspects of aviation 
safety — and recognition of the additional services the 
naval aviation physiologist can provide — has made the 
physiologist an integral part of the AMSO team. 

Recent developments in aviation physiology have in- 
cluded interservice programs with the Air Force. 

In 1976, LCDR Terrence J. O'Leary (MSC), HM1 
Billy J. Cox, and HM1 Claude Carroll became the first 
naval aviation physiologist and aviation physiology 
technicians to work in an Air Force training unit (at 
Andrews AFB, Md.). 

Simultaneously, CAPT John Graham, BSC, USAF, 
became the first Air Force physiological training officer 
to work in a Navy training unit (at Barbers Point, 
Hawaii). 

In February 1977, HM2 John Lawlor, HM2 Jeffrey L. 
Munson, HM2 James Neeley, and HM3 Marlon Evans 
became the first aviation physiology technicians to be 
trained by the Air Force (at Brooks AFB, Tex.). 



The history of any program is a history of people. 
The people in this program have always been will- 
ing to take on the job at hand — with a can-do spirit 
and with devotion to the U.S. Navy. Their spirit and 
enthusiasm have brought growth to this program 
while — in these times of austerity — others have not 
fared as well. 



References 

1. West VR, Every MG, Parker JF Jr (eds): U.S. Naval Aerospace 
Physiologist's Manual. NAVAIR 00-80T-99, 1972, pp 1-21. 

2. Rickard HJ: Medicos in the stratosphere. Contact 1:12-17, Aug 
1941. 

3. Williams NE, Ban- NL: The History of the Medical Department 
of the United States Navy in World War II. NAVMED P-5031, 1953, 
pp 212-218. 

4. Boaz TD: Low pressure chamber installed at the Naval Air 
Station, Pensacola, Florida. US Nav Med Bull 40(2); 429-439, 1942. 

5. Pollard JP: Some aspects of physiology training in naval 
aviation. Milit Med 126:133-139, 1961. 



Volume 69, September 1978 



17 



Hospital Corps Career Decision: 



The Time Is Now! 



If you're contemplating leaving 
the Hospital Corps because you 
think your advancement opportuni- 
ties, educational pursuits, or 
chances for travel and rewarding 
assignments are stifled, think 
again. 

Advancement. The chances for 
advancement within the Hospital 
Corps are increasing. The following 
breakdown portrays the selection 
and advancement of hospital corps- 
men, E-4 through E-9, during the 
most recent advancement cycle: 

• E-9: 106 board eligible; 44 
(41.5%) selected. 

• E-8: 651 board eligible; 122 
(18.7%) selected. 

• E-7: 704 board eligible; 323 
(45.9%) selected. 

• E-6: 942 test takers; 381 
(40.4%) advanced. 

• E-5: 2,198 test takers; 683 
(31.0%) advanced. 

• E-4: 1,688 test takers; 1,688 
(100%) advanced. 

As can readily be determined, 
advancement within the Hospital 
Corps is alive and well. 

Education. The Hospital Corps 
has 31 advanced schools available 
for qualified men and women. The 
training for health-care paraprofes- 
sionals in today's Hospital Corps is 
commensurate with — and in many 
cases better than — civilian training. 
The list of advanced studies below 
is indicative of opportunities as they 
are today and will be tomorrow: 

Nuclear Submarine Medicine 
Aviation Medicine 
Surface Nuclear Medicine 
Cardiopulmonary 



18 



Aviation Physiology 

Clinical Nuclear Medicine 

Advanced Hospital Corps 

Preventive Medicine 

Transplantation 

Ocular 

Otolaryngology 

Radiology 

Electroencephalography 

Optician 

Physical /Occupational Therapy 

Medical Photography 

Biomedical Equipment, Basic 

Biomedical Equipment, X-ray 

Biomedical Equipment, Electronics 

Pharmacy 

Operating Room 

Neuropsychiatry 

Urology 

Special Operations 

Medical Deep Sea Diving 

Dermatology 

Basic Laboratory 

Cytology 

Histopathology 

Advanced Laboratory 

Medical Technologist 

Many of the above courses of in- 
struction are wide open to qualified 
candidates. Among these are Nu- 
clear Submarine Medicine; Ad- 
vanced Hospital Corps; Preventive 
Medicine; Optician; Biomedical 
Equipment, X-ray; Biomedical 
Equipment, Electronics; Pharmacy; 
and Special Operations. 

Corpsmen with certain technical 
skills are paid extra money upon re- 
enlistment and during their tours of 
duty. These are generally the opera- 
tional skills, such as Nuclear Sub- 
marine Medicine, Special Opera- 
tions, and Medical Deep Sea Div- 
ing. 

Several Hospital Corps schools 
are affiliated with, and accredited 
by, civilian colleges and universi- 



ties, and students receive college 
credit upon completion of the 
course. 

Billets. Navy Hospital Corps bil- 
lets are available in every state in 
the Union and at many overseas 
locations. Depending on skills pos- 
sessed, pay grade, performance, 
etc., hospital corpsmen can look 
forward to rewarding tours of duty. 
A recent survey revealed that ap- 
proximately 75% of all assignments 
were made based on the duty pref- 
erences of the individual. 

The Guard II program, soon to be 
replaced by Guard III, allows quali- 
fied hospital corpsmen literally to 
select their next duty station as a 
reenlistment incentive. This pro- 
gram rewards good performance 
and definitely allows the corpsman 
to detail himself. 

If you take into account: 

• the opportunity for advance- 
ment, 

• the opportunity to acquire a 
technical skill within the health- 
care field, 

• the opportunity to pursue your 
education, 

• the opportunity to select your 
next assignment, 

• the opportunity to increase 
monetary rewards, 

• the opportunity to be a part of 
the best health-care system in the 
Armed Forces, and 

• the opportunity to perform a 
service to your shipmates — 

The time to decide on a career in the 
Hospital Corps is now! 

— HMCM Marty Luchter, USN, Senior 
HM Detailer, BUPERS 

U.S. Navy Medicine 



lui rtLuiNu itiis una 



NOTES 



ROSTER-1 AUGUST 1978 



Fallowing is a list of stuff medical end dental officers of major fleets and forces; 
district medical and denial officers; commanding officers; executive officers: direc- 
tors of administrative services: directors of clinical sendees; chief nurses of Medical 
Department activities; division surgeons and dental officers of Marine divisions. 
Marine aircraft wings, and Marine brigades. 



□ 

M 
□ 



C1NCPACFLT/CINCPAC(ADDU) RADMD.E. BROWN. JR., MC, USN (ADDU) 

U ™™ FLT CAPTN.D. WILKIE. DC, USN (ADDU) 

CINCPACFLT AO CAPT J. WOLF. MSC. USN 

C1NCLANT/CINCLANTFLT/SACLANT 

(COMTRALANT) RADM E.P. RUCCI MC USN 

CINCLANT/CINCLANTFLT/CINCWESTLANT RADM J.B. HOLMES DC USN 

QNO.ANTFLT AO CDR W. BRANSCUM, MSC, USN 

SACLAN r A0 CDR W.I. CASLER. MSC, USN 

CINCUSNAVEUR CAFTH.E. SHUTE, MC, USN (ADDU) 

CAPT R.S. NOLF. DC, USN (ADDU) 

COMNAVFORJAPAN CAPT B.L. JOHNSON, MC, USN (ADDU) 

CAPTE.T. WJTTE. DC, USN [ADDU) 

COMNAVLOCJSTICS RADM D.E. BROWN, JR., MC. USN 

AO CDR C.A. ROPER. MSC. USN 

COMNAVAIRLANT CAPT R.P, CAUDILL. MC, USN 

CAFr S. W. PERAND, DC, USN (ADDU) 

COMNAVAIRPAC CAPT F.E. DULLY, MC, USN 

CAPT A.L. DAVY, DC, USN (ADDU) 
AO LCDR C. SCHMUTZ. MSC, USN 

COMSUBLANT CAPT B.J. BLANKENSHIP, MC. USN 

COMSUBPAC CAPT R.T. LARSEN, MC. USN 

CAPT N.D. WILKIE, DC, USN (ADDU) 

CNET(NAS PNCLA) RADM R.L. BAKER, MC. USN (ADDU) 

CAPTT.W. MC KEAN, DC, USN (ADDU) 
AOCAPTS.D. BARKER, MSC. USN (ADDU) 

CNATECHTRA (NAS MEMPHIS. TN) CAPT C.W. BRAMLETT, MC. USN (ADDU) 

CAPT D.G. GARUER, DC, USN (ADDU) 
AO LCDR W.F. BENEDICT, MSC, USN 

CNAT (NAS CORPUS CHRIST], TX) CAPT T.J. TRUMBLE, MC. USN (ADDU) 

COMNAVSURFLANT C APT W.M. PHILLIPS. MC, USN 

CAPTC.E. BRANYAN. DC, USN (ADDU) 

COMNAVSUKFPAC CAPT J. W. JOHNSON. MC, USN 

CAPT R.E. THOMAS. DC. USN (ADDU) 
AO LCDR R.W. BARNHILL, MSC, USN 

COMNAVFORCARIB/COM ANTILLES DEF COMD .... CAPT P.C. GREGG, MC, USN (ADDU) 

CAPT D.E. BARLOW. DC. USN (ADDU) 

COMFAIRMED CAPT J.A. MC KINNON, DC, USN (ADDU) 

COMICEDEFOR CAFL M.C. CLEGG. DC, USN (ADDU) 

COMTRAWING 4 CAPT A.D. SORF.NSON. DC. USN (ADDU) 

OPNAV CAPT C.A. BROWN. DC, USN (ADDU) 

OFFNAVRF.SCH. WASHINGTON. DC CAPT J.F, KELLY. DC. USN (ADDU) 



FIHST NAVAL DISTRICT 

NAVREGMEDCLINIC, PORTSMOUTH. NH . 

NAVREGMEDCEN, NEWPORT. RI 



NAVREGDENCEN, NEWPORT. RI . 



DMO CAPT V.L. STOTKA. MC, USN (ADDU) 
DDO CAPT W.A. PETERSON. DC, USN 

CO CDR D.W. REEVES, MSC, USN 
XO LCDR D. MC DERMOTT. MSC, USN 
SRNURSECDR M. BRAXMAN, NC, USN 

. CO CAPT V.L. STOTKA, MC. USN 
DCS CAPT CM. VOYLES, MC, USN 
DAS CDR N.K. OWENS, MSC, USN 
CH NURSE CAPT L. ROBINSON, NC, USN 

CO CAPT W.A. PETERSON, DC, USN 
DCS CAPT C.J. SCHULTZ, DC, USN 
DAS LTJ.C. WANAMAKER. MSC, USN 



THIRD NAVAL DISTRICT 

SUB MEDICAL CENTER. NEW LONDON, CT . 



SUBMEDRSCHLAB. GROTON, CT - 
FOURTH NAVAL DISTRICT 



DMO CAPT L.H. SEATON, MC, USN (ADDU) 
AOLTD. SUTTLE, MSC, USN (ADDU) 

. CO CAPT L.H. SEATON, MC. USN 
DCS CAPT R.B. JOHNSON, MC, USN 
DAS CAPT F.G.ANDERSON, JR., MSC. USN 
CH NURSE CAPT A. BARKER, NC, USN 

. CDR R.A. MARGULIES, MC. USN 



NAVREGMEDCEN. PHILADELPHIA, PA . 



NAVREGDENCEN. PHILADELPHIA, PA . 



NAVAL MEDICAL MATERIAL SUPPORT 
COMMAND, PHILADELPHIA, PA 



FIFTH NAVAL DISTRICT . 



NAVREGMEDCEN, PORTSMOUTH, VA . 



NAVAL SCHOOL OF HEALTH SCIENCES, 
PORTSMOUTH, VA 



NAVREGDENCEN, NORFOLK, VA . 



NAVAL BASE, NORFOLK, VA 

NAVAL OPHTHALMIC SUPPORT & TRAINING 
ACT, WILLIAMSBURG, VA 



DMO CAPT R.A. BAKER, MC. USN (ADDU) 
DDO CAPT A.F, REID, DC, USN (ADDU) 
AOLTJ.N. GALLIS, MSC. USN (ADDU) 

CO CAPT R.A- BAKER, MC, USN 
DCS CDR CT. CLOUTIER. MC, USN 
DAS CAPT H.S. RUDOLPH, MSC, USN 
CH NURSE CAPT A. FOLEY, NC. USN 

CO CAPT A.F, REID, DC, USN 

DCS CAPT H.E. FREEBURN. JR.. DC. USN 

DAS LT O.J, SANTORE, JR., MSC, USN 

. CO CAPT O, STALLINGS, MSC USN 
XOLCDRR.P. LEGG, MSC, USN 



. DMO RADM G-E. GORSUCH, MC, USN (ADDU) 
D1R DENACTYS RADM J. B.HOLMES. DC. USN 

(ADDU) 
AO LCDR R.M. CURRAN. MSC. USN (ADDU) 

. . CO RADM G.E. GORSUCH, MC, USN 
DCS CAPT J.W. HAYES, MC, USN 
DAS CAPT D.E. SHULER, MSC, USN 
CH NURSE CAPT M.P. BRENN AN. NC, USN 

. OIC CAPT B.A.MC KAY, NC, USN 
AO LT G. MURPHREE, MSC, USN 

. . CO RADM J. B. HOLMES, DC, USN 
DCS CAPT W.E. 0U1LTER, JR.. DC, USN 
DAS CDR C.A. WESOLOWSKI. MSC. USN 

. . RADM J.B. HOLMES, DC, USN (ADDU) 



NAVHOSP, CHERRY POINT, NC . 



NAVREGMEDCEN. CAPM LEJEUNE, NC . 
NAVREGDENCEN, CAMP LEJEUNE, NC . 



ENVIRONMENTAL AND PREV MED UNIT 
TWO. NORFOLK, VA 



CO CAPT, I. G. WILCOX, MSC, USN 
XO CDR H.L. GOOCH, MSC, USN 

. CO CAPT D.E. STILL, MSC USN 
DCS CAPT W.W. HODGE, MC. USN 
DAS LCDR J, W. BALDWIN, MSC USN 
CH NURSE CDR E. CARSON, NC, USN 

CO CAPT J.L. HUGHES, MC USN 
DCS CAPT R.J. SEELEY, MC, USN 
CH NURSE C APT T, PROTO. NC USN 

. CO CAPT N.K. LUTHER. DC, USN 
DCS CAPT T.L. WHATLEY, DC. USN 
DAS LCDR R.J. LINDSAY. MSC, USN 

. OIC CAPT H.J. CANDELA, MC, USN 
AO LT H.T. BROWN. MSC, USN 



COMNAVMARIANAS CAPT R.D. PRINCE, DC, USN (ADDU) 



CAIRO, EGYPT 

US. NAVMEDRSCHUNIT#3 . 



CO CAPT R.H. WATTEN, MC. USN 

AOLTD.L. WHEELER, MSC, USN 
SR NURSE CDR S. ROSS, NC, USN 

TAIWAN 

U.S. NAVHOSP, TAIPEI CO CDR CM. DAY III, MC, USN 

SR NURSE LCDR C. ZERBATO, NC, USN 



U.S. NAVMF.DRSCHUN1T #2. TAIPEI. 



PHILIPPINES 

U.S. NAVREGMEDCEN. SUBICBAY. ROP , 



U.S. NAVREGDENCEN. SUBIC BAY, ROP . 



. CO CDR K. SORENSEN. MC. USN 
AO LCDR S.A. NESS, MSC, USN 



CO CAPT R.A. PROULX, MC, USN 
DAS CDR R.M. COAN, MSC, USN 
CH NURSE CDR E. O'NEILL, NC, USN 

. CO CAPT M.M. STEVENS, DC, USN 
DCS CAPT J. F. LESSIG, DC, USN 
DASLTN.E. CARROLL. MSC. USN 



SPAIN 

U.S. NAVHOSP, ROTA COCAPT J. E. WILSON. MC, USN 

DAS CDR C.A. HARTMAN, MSC USN 
CH NURSE CDR H. HOLBROOK, NC, USN 

COMNAVACT. SPAIN CAPT G.B. CROSSMIRE, DC, USN (ADDU) 

HEADQUARTERS MARINE CORPS AND FLEET MARINE FORCE 

HEADQUARTERS, U.S. MARINE CORPS CAPT G.E. GRIFFIN II], MC, USN 

CAPT F.R. RUL1FFS0N, DC USN 
AOCDRG.S, HARRIS. MSC. USN 

HEADQUARTERS, FMF ATLANTIC CAPT R.R. PALUMBO, MC, USN 

FORDO CAPT R.S. DAVISON, DC, USN 
AO LCDR R.F. COXE, MSC, USN 

SECOND MARINE DIVISION SURGEON CAPT R.M. LEHMAN, MC, USN 

SECOND FORCE SERVICE SUPPORT GROUP SECOND DENCO CAPT R.A. GASTON, DC, USN 

SECOND FORCE SERVICE SUPPORT GROUP 22ND DENCO FORTRPS CAPT J. S. K1TZMILLER, DC, 

USN 
AO LCDR M.T. MEANEY, MSC, USN 

SECOND MARINE AIRCRAFT WING CAPT E.L. GEHRY, MC USN 

SECOND FORCE SERVICE SUPPORT GROUP 12TH DENCO CAPT D.T, FENNER, JR., DC. USN 

AOLT J. L.JOHNSON, MSC, USN 

HEADQUARTERS, FMF PACIFIC CAPT R.W. JONES, MC, USN 

FORDO CAPT P.C ALEXANDER. DC USN 
AP CAPT L.W. GAY, MSC, USN 

FIRST MARINE DIVISION CDR R.C. HODGES, MSC. USN 

FIRST FORCE SERVICE SUPPORT GROUP FIRST DENCO CAPT B.F. KRESL, DC, USN 

AO LCDR J.T. LEWIS. MSC, USN 

FIRST MARINE AIRCRAFT WING CDR D.S. ANGELO, MC USN 

THIRD FORCE SERVICE SUPPORT GROUP (DETA) . .. 1ITHDENC0 CAPT .I.E. MILLER. DC. USN 

AO LT R.T. F1GURA, MSC, USN 

FIRST MARINE BRIGADE CDR M.O. ABBOTT, MC, USN 

21ST DENCO CAPT L.M. MULDROW, JR., DC, USN 
AO LCDR W.M. MC CLANNAHAN, MSC, USN 

THIRD MARINE DIVISION SURGEON CAPT D.R. HAULER, MC, USN 

THIRD FORCE SERVICE SUPPORT GROUP THIRD DENCO CAPT R.E. CASSIDY, DC. USN 

AO LCDR J.J. BIELAWSKI. MSC, USN 

THIRD MARINE AIRCRAFT WING CAPT G.E. BALYEAT, MC. USN 

FIRST FORCE SERVICE SUPPORT GROUP I3TH DENCO CAPT R.E. WILLIAMS, JR.. DC, USN 

AO LCDR M. ICZK0WSK1, MSC, USN 

FLDMEDSERVSCOL, CAMP PENDLETON CO CAPT W.H. JONES, MSC, USN 

XO LCDR E.J. LOOS. MSC. USN 

FLDMEDSERVSCOL, CAMP LEJEUNE CO CAPT E.J. STEWARD. MSC. USN 

XOCDRJ.M, CORRELL, MSC, USN 

— This roster was prepared by BUMED Code 312. 



CUT ALONG THIS LINE 



NATIONAL NAVAL MEDICAL CENTER. 
BETHESDA, MD 



NATIONAL NAVAL DENTAL CENTER. 
BETHESDA, MD 



NAVAL HEALTH SCIENCES EDUCATION AND 
TRAINING COMMAND. NNMC. BETHESDA. MD . 



NAVSCOLHELCAREADMIN. BETHESDA. MD . 
NAVMEDRSCHINSTITUTE. BETHESDA, MD . . 
NAVMEDRSCHDEVCOM. BETHESDA, MD . . . 



ARMED FORCES INST OF PATHOLOGY. 
WASHINGTON, DC 



ARMED FORCES RADIOBIOLOGY RESEARCH 
INSTITUTE, BETHESDA. MD 



NAVAL MEDICAL DATA SERVICE CENTER, 
BETHESDA. MD 



NAVHOSP. PATUXENT RIVER, MD . 



NAVHOSP, QUANT1CO, VA . 



ITALY 

U.S. NAVREGMEDCEN, NAPLES - . 



U.S. NAVREGDENCEN. NAPLES . 



U.S. NAVAL ENVIRONMENTAL AND PREV MED 
UNIT HI. NAPLES 



CORADM J.T. HORGAN, MC. USN 

DCS CAPT M. N1EVES. JR., MC, USN 

DAS CAPT H.P. MILLER, MSC, USN 

CH NURSE CAPT H. FURMANCHIK. NC, USN 

CO CAPT S.T. ELDER, DC, USN 
DCS CAPT R.D, CULLOM. DC, USN 
DAS CDR M.K. LAW, MSC. USN 

. CO RADM S. BARCHET, MC. USN 
XO CAPT D.M. ALLMAN, DC, USN 
AO LCDK R.E. NEWMAN, MSC. USN 

. CO CAPT W.J. AUTON, JR.. MSC, USN 
XOCDRD.R. CRAIG. MSC, USN 

COCAPTW.F. MINER, MC, USN 
AO CDR R.A. MORIN, MSC, USN 

CO CAPT J.D. BLOOM, MC, USN 

EXEC ASST CDR W. SCHROEDER, MSC, USN 

DIR CAPT E.C. COWART, JR.. MC. USN 

DIR COL L.W.R. STROMBERG. USA 
AO CAPT E.D. M ATIF.K, MSC. USN 

COCAPTL.E. ANGELO, MSC, USN 
XOLCDR K.W.GIBSON. JR., MSC, USN 

CO CDR E.R. CHRISTIAN, MSC, USN 

DCS CAPT J, P. SENN, MC, USN 

DAS LT M.A. BLOME, MSC, USN 

CH NURSE CAPT D.H. HOOKER, NC. USN 

CO CDR J. R. ERIE, MSC, USN 
DCS CAPT J. A. OLSEN, MC, USN 
DASLCDRD.D. WILSON, MSC, USN 
CH NURSE CDR M.F. HALL, NC, USN 



. CO CAPT N.W. COOLEY, MC, USN 
DCS CAPT J.V. SHARP, MC, USN 
DAS CDR J, A. BOYLE, MSC, USN 
CH N URSE CAPT C. S H EA , NC, USN 

CO CAPT J. A. MCKINNON, DC, USN 
DCS CAPT J.T. JANUS, DC. USN 
DAS CDR P.T. RAY, MSC. USN 

. OICCDR J.W. POUNDSTONE. MC, USN 
AO LCDR D.E. ANDERSON. MSC, USN 



JAPAN 

U.S. NAVREGMEDCEN, YOKOSUKA . 



U.S. NAVREGDENCEN, YOKOSUKA . 



U.S. NAVREGMEDCEN, OKINAWA . 



MARIANA ISLANDS 

U.S. NAVREGMEDCEN, GUAM . 



U.S. NAVREGDENCEN. GUAM . 



CO CAPT B.L. JOHNSON, MC. USN 
DCS CDR J. P. SMYTH. MC, USN 
DAS LCDR T.F.. THOMAS, MSC. USN 
CH NURSE CAPT D. CORNELIUS, NC. USN 

. CO CAPT E.T. WITTE. DC, USN 
DCS CAPT R.E. HOWE, DC, USN 
DAS LCDR E.C. PIERSOL, MSC, USN 

COCAPTC.S. LAMBDIN, MSC, USN 

DAS CDR C, MOORE, MSC. USN 

CH NURSE CAPT M. CONLEY. NC. USN 

. CO CAPT M.C. CARVER, MC. USN 
DCS CAPT R.G. SABLAN, MC. USN 
DAS LCDR K.L. LASHLEY, MSC, USN 
CH NURSE CDR F. FRAZIER. NC, USN 

CO CAPT R.D. PRINCE, DC, USN 
DCS CAPT H.CDEATON, DC. USN 
DAS LCDR O.H. GRISHAM. MSC. USN 



SIXTH NAVAL DISTRICT 

NAVREGMEDCEN. CHARLESTON. SC . 

NAVREGDENCEN. CHARLESTON, SC . 



NAVAL BASE. CHARLESTON, SC . . . 
NAVHOSP. BEAUFORT. SC 



NAVREGDENCEN, PARRIS ISLAND, SC . 



NAVREGMEDCEN, JACKSONVILLE, FL . 



NAVREGDENCEN, JACKSONVILLE. FL . 



NAVHOSP, KEY WEST, FL . 



NAVREGMEDCEN, MEMPHIS, MILL1NGTON, TN . 



NAVREGMEDCEN, ORLANDO. FL . 



NAVREGDENCEN, ORLANDO. FL 

NAVAEROSPREGMEDCEN, PENSACOLA, FL . 



NAVREGDENCEN, PENSACOLA, FL . 



NAVAEROMEDRSCHLAB. PENSACOLA. FL . . 
NAVAEROSPACEMEDINST, PENSACOLA, FL. 



DISEASE VECTOR ECOLOGY AND CONTROL 
CENTER, JACKSONVILLE, FL 



EIGHTH NAVA1 DISTRICT 

NAVREGMEDCEN, CORPUS CHRISTI, TX , 



NAVREGMEDCEN. NEW ORLEANS. LA . 



. . DMO CAPT I.J. WOODSTEIN, MC. USN (ADDU) 
DDO CAPT R.G. GRANGER, DC, USN (ADDU) 
AO LCDR R.K. GREEN, MSC. USN (ADDU) 

. CO CAPT l.J. WOODSTEIN, MC, USN 
DCS CAPT R.E. TOBEY, MC. USN 
DASCDRG.M. ELLIS, MSC, USN 
CH NURSE CAPT R. PAMPUSH, NC, USN 

. CO CAPT R.G. GRANGER, DC. USN 
DCS CAPT T.M. ALLENSWORTH, JR.. DC. USN 
DAS LTD.C. DUNKLEMAN. MSC. USN 

. CAPT R.G. GRANGER, DC. USN (ADDU) 

. CO CAPT D.C. GOOD, MC, USN 
DCS CAPT W.R. MULLINS, MC, USN 
DAS CDR W. BLANKENSHIP, MSC, USN 
CH NURSE CAPT B. SLATER, NC. USN 

. CO CAPT H.J. SAZIMA, JR., DC, USN 
DCS CAPT A. HERR, DC, USN 
DAS LCDR L.R. MAASSEN, MSC. USN 

. CO CAPT W.J. MCDERMONT.JR..MC, USN 
DCS CAPTN.R. RAFFAELLY. MC. USN 
DAS CAPT LJ. SCHAFFNER, MSC, USN 
CH NURSE CAPT M.J. WALKER. NC. USN 

. COCAPTE.E. MCDONALD, JR., DC, USN 
DCS CAPT E.H. PLUMP, DC, USN 
DAS CDR R.L. WENTWORTH, MSC. USN 

. CO CAPT P.F. WELLS 11, MC, USN 
DAS LCDR F.D.R. FISHER, MSC, USN 
CH NURSE CAPT D. DUNN, NC, USN 

. CO CAPr C,W. BRAMLETT. MC, USN 
DCS CAPT G.C. BINGHAM, MC. USN 
DAS CDR B.L. STEPHENS, MSC, USN 
CH NURSE CAPT M. MAYNARD. NC, USN 

. CO CAFr J.A. ZIMBLE, MC, USN 
DCS CAPT W.A. SCHEFSTAD, MC. USN 
DAS CDR L.H. TURBEVILLE. MSC. USN 
CH NURSE CAPT J.M. REDGATE, NC. USN 

. CO H.C. FUND, JR., DC. USN 
DCS CAPT H.S. SAMUELS, DC. USN 
DAS LCDR P.N. ACKLEY, MSC, USN 

CO RADM R.L. BAKER, MC, USN 
DCS CAPT N.D. BROUSSARD, MC, USN 
DAS CAPT S.D. BARKER, MSC. USN 
CH NURSE CAPT K. WILSON, NC, USN 

CO CAPT T.W. MC KEAN, DC, USN 
DCS CAPT S.E, PEPEK, DC, USN 
DAS LCDR P.R. COWART. MSC, USN 

CO CAPT R.E. MITCHEL, MC, USN 

CO CAPT H.S. TROSTLE, MC. USN 
XO CAPT D.J. BRIDEAU. MSC, USN 



OICi.CDRL.L. SHOLDT, MSC, USN 
AO LT B.R. FORO, MSC. USN 



. DMO CAPT P.D. COOPER, MC. USN (ADDU) 
DDO CAPT A.J. BARTOSH. DC. USN (ADDU) 

CO CAPTT.J. TRUMBLE. MC, USN 
DCS CAPT D.W. PEACE, JR., MC, USN 
DAS CDR W.A, GODFREY, JR., MSC, USN 
CH NURSE CAPT M, DONOGHUE, NC. USN 

CO CAPT P.D. COOPER, MC, USN 
DAS CAPT J. L. GRAVES, MSC, USN 
CH NURSE CAPT B. NAGY.NC, USN 



NINTH NAVAL DISTRICT . 



NAVREGMEDCEN. GREAT LAKES. ]L . 



NAVREGDENCEN. GREAT LAKES, 1L . 



NAVDENTALRSCHINSTITUTE, NB, 
GKEATLAKES.IL 



NAVHOSPCORPSCOL, GREAT LAKES, IL . 



NAVENVIRHI.THCEN. CINCINNATI, OH . 



DMOCAPTM.J. VALASKE, MC, USN (ADDU) 
DIR DENACTY5 CAPTC.J. MC LEOD, DC. USN 

(ADDU) 
AO ENS T.P. CORMIER, MSC, USN 

CO CAPT M.J. VALASKE, MC. USN 
DCS CAP'!' L.R. FOUT, MC, USN 
DAS LCDS R.A, PAYTON, MSC, USN 
CH NURSE CAPT E.M. PFEFFEE. NC. USN 

. CO CAPT C. J , MC LEOD, DC, USN 
DCS CAPT H.B. MC WHORTER, DC. USN 
DAS CDR P.J. COLLIER, MSC, USN 

COCAPTM.R, WIRTHLIN, JR., DC, USN 

. COCDRC.J.THEISEN, JR., MSC. USN 
XO LCDR F. BRIAND, MSC, USN 
SR NURSE CDR P. FLEURY, NC. USN 

. OIC CAPT T.N, MARKHAM, MC, USN 
MED ADM OFF LT F.C. HARDY, MSC, USN 



TENTH NAVAL DISTRICT 

NAVHOSP, GUANTANAMOBAY . 



COMNAVB GU ANTAN AMO BAY 

NAVHOSP, ROOSEVELT ROADS, PR . 



NAVREGDENCEN, ROOSEVELT ROADS. PR . 



ELEVENTH NAVAL D1STHICT 



NAVREGMEDCEN, CAMP PENDLETON. CA . 

NAVREGDENCEN, CAMP PENDLETON, CA . 
NAVREGMEDCEN, LONG BEACH, CA 



NAVREGDENCEN. LONG BEACH. CA . 



NAVAL SCHOOL OF HEALTH SCIENCES, 
SAN DIEGO, CA 



DMO CAPT P.C.GREGG, MC. USN (ADDU) 
DDOCAPT D.E. BARLOW, DC. U?N (ADDU) 

CO CAPT R.P. BISHOP, MC. USN 
DAS LCDR R. REL1NSKI, MSC. USN 
CH NURSE CDR F. DAVISON, NC, USN 

DO CAPT J. R. BOHACEK, DC. USN (ADDU) 

CO CAPT P.C. GREGG, MC, USN 

DAS CDR H.B. LEVANDOWSKI. JR-, MSC, USN 

CH NURSE CAPT C. FINN, NC, USN 

CO CAPT D.E. BARLOW, DC. USN 
DCS CAPT R.A. MURPHY, DC, USN 
DASLT W.M. MILLS. MSC. USN 



DMO RADM J.W. COX, MC. USN (ADDU) 
DIRDENACTYS RADM W.L. DARNALL, JR.. 

(ADDU) 
AO CDR J. B. KNIGHT. MSC. USN (ADDU) 

CO CAPT CH. LOWERY, MC. USN 
DCS CAPT D. RE1D, MC, USN 
DAS CAPT F.C. P1TTINGT0N, MSC, USN 
CH NURSE CAPT P. PORTZ, NC, USN 

. CO CAPT WE. SUGG, JR., DC, USN 
DCS CAPT J. D. MAHONEY. DC, USN 
DAS LCDR J. D. GALBREATH, MSC, USN 

CO CAPT Q.E. CREWS, MC, USN 
DCS CAPT E.E, FREEMAN, MC, USN 
DAS LCDR D.N. BENANDER, MSC, USN 
CH NURSE CAPT A. WILLIAMS. NC, USN 

. CO CAPT H..W. HODSON. DC, USN 
DCS CAPT F.A. PAPERA, DC, USN 
DASLTG.R. HARRINGTON, MSC. USN 

. COCAPTW.E. MCCONVILLE, MSC. USN 
XOCDRG.E. HAMMETT. MSC, USN 
SR NURSE CAPT M, PERLOW, NC. USN 



ENVIRONMENTAL AND PREV MED UNIT #5. 
SAN DIEGO. CA 



NAVHOSP. PORT HUENEME, CA . 



NAVREGMEDCEN. SAN DIEGO. CA . 



OIC CAPT S.J. KENDRA. MC, USN 
AO LT D.R, GRAY. MSC. USN 

CO CDR .I.E. JOHNS. MSC, USN 
DCS CAPT T.E. CARSON. MC, USN 
DAS LCDR S.J. PROFITA, MSC, USN 
CH NURSE CDR C, BELEZOS. NC, USN 

CO RADM J.W. COX. MC, USN 
DCSCAFTJ.S, CAS5ELS.S, MC, USN 
DAS CAPT E.N. BUCKLEY, MSC, USN 
CH NURSE CAPT F. SHEA. NC, USN 



NAVREGDENCEN, SAN DIEGO, CA . 



CO RADM W.L. DARNALL. JR., DC, USN 
DCS CAPT E.J. HEINKEL, JR., DC, USN 
DAS CDR W.E. GROCE. MSC. USN 



NAVHLTHRSCHCEN, SAN DIEGO, CA 

COMNAVBASE, LOS ANGELES DOCAPTH.W. HODSON. DC. USN (ADDU) 



CO CAPT R.H. RAHE, MC, USN 
XO LCDR W. FERRIS, MSC, USN 



TWELFTH NAVAL DISTRICT DMO RADM W.M. LONERGAN, MC, USN (ADDU) 

NAVREGMEDCEN, OAKLAND, CA CO RADM W.M. LONERGAN, MC, USN 

DCS CAPT L.U, PULICICCHIO, MC, USN 
DAS CAPT H.H. SOWERS, MSC, USN 
CH NURSE CAPT L, PETERSON, NC, USN 

COMPATWINGSPAC MFT DO CAPT W.C. SULLIVAN, DC, USN (ADDU) 

NAVHOSP. LEMOORE, CA CO CAPT J.J. PALMER, MSC, USN 

DCS CAPT E.L. BINGHAM, MC, USN 
DAS CDR F. TEAGUE, MSC, USN 
CH NURSE CD" J.BARNES. NC, USN 

NAVREGDENCEN. SAN FRANCISCO, CA CO CAPT J. E. HYDE, DC, USN 

DCS CAPT R.P. MORSE, DC, USN 
DAS CDR G, RAMIREZ, MSC, USN 

NAVD1SVECTECOLC0NCEN, ALAMEDA, CA OIC LCDR R.V. PETERSON. MSC, USN 

AO LT T.W. WILDER, MSC, USN 

NAVBIOSCILAB, OAKLAND. CA CO CAPT J.F. PR1BN0W. MSC, USN 

AO LTJG J-D. FORD, MSC, USNR 



THIRTEENTH NAVAL DISTRICT . 



NAVREGMEDCEN, BREMERTON, WA . 



NAVREGDENCEN, BREMERTON, WA . 



NAVHOSP, WHIDBFY ISLAND, OAK 
HARBOR, WA 



NAVCL1N1C. NSA, SEATTLE, WA . 



FOURTEENTH NAVAL DISTRICT . 



NAVREGMEDCL1NIC, PEARL HARBOR, HI . 



NAVREGDENCEN, PEARL HARBOR, HI , 



DMO CAPT R.C. ELLIOTT, MC, USN (ADDU) 
DDOCAPTRG. THOMPSON, DC, USN (ADDU) 
AO LCDR K.W. SHAFFER. MSC. USN (ADDU) 

CO CAPT R.C. ELLIOTT, MC, USN 

DAS CDR D.D. PALMER, MSC, USN 

CH NURSE CAPT M,G. STEWART, NC, USN 

CO CAPT R.G. THOMPSON, DC, USN 
DCS CAPT J.F. SCOTT. DC, USN 
DAS LT C.E. LAND. MSC. USN 

COCDRG.W. BALDAUF, MSC, USN 
DCS CAPT D.W. COWHERD, MC, USN 
DAS CDR P.O. DILLEY, MSC, USN 
CH NURSE CDRK. KENDALL, NC. USN 

CO CAPT R.L, SURFACE, MSC, USN 
XO LCDR K.W. SHAFFER, MSC, USN 
SR NURSE LCDR V.E. BOYCE, NC, USN 



DMO CAPT A.L, SOLGAARD, MC, USN (ADDU) 
DDOCAPTN.D. W1LKIE, DC, USN (ADDU) 
AO CDH D.R. FERGUSON, MSC, USN (ADDU) 

CO CAPT A.L. SOLGAARD, MC, USN 
DAS CDR D.R. FERGUSON, MSC, USN 
SR NURSE CAPT A. GOMES, NC, USN 

CO CAPT N.D. WILKIE, DC. USN 
DCS CAPT A.D. L01ZEAUX, DC, USN 
DAS LCDR J. D. DELAUGHTER, MSC, USN 



NAVMEDADMUNIT TRIPLER ARMY HOSP. 

HONOLULU, HI OIC 

ENVIRONMENTAL AND PREVENTIVE MEDICINE 

UNIT #6, PEARL HARBOR, HI OIC CAPT T.R. BYRD, MC, USN 



NAVAL DISTRICT, WASHINGTON, DC . 

NAVHOSP, ANNAPOLIS. MD 



AO LT JM. CONSENZA. MSC. USN 



DMO RADM J.T. HORGAN. MC, USN (ADDU) 
DDO CAPT ST. ELDER, DC, USN (ADDU) 

CO CAPT J. D. PRUITT, MSC, USN 

DCS CAPT W,J, WAGNER, MC. USN 

DAS LCDR L.L. MOORE, MSC, USN 

CH NURSE CAPT L. N1CKERS0N, NC, USN 



IMAVMED Newsmakers 



Not content simply with caring for 
inpatients, nurses and hospital 
corpsmen at NRMC San Diego are 
volunteering off-duty time to teach 
cardiopulmonary resuscitation tech- 
niques to crewmembers of afloat 
commands in the area. 

The CPR presentation is offered 
in conjunction with the American 
Heart Association and leads to certi- 
fication by that organization. To 
date, the San Diego project has re- 
sulted in certification of more than 
200 crewmembers. 

In the photo, LCDR Elizabeth D. 
Kunc (NC), teaches CPR basics to 
crewmembers of the USS Blue 
Ridge (LCC-19). 

When LT Jerry W. Rose (MC) com- 
pleted his internship at NRMC Oak- 
land in June, he got a bonus: the 
wings of a Navy flight surgeon. 

Rose had enrolled in the six- 
month flight surgeon program 
(which includes six weeks of flight 
training) as an elective during his 
senior year of medical school at the 



University of Washington. 

Normally, the program is open 
only to physicians who have already 
completed a one-year internship. 
According to records at the Naval 
Aerospace Medical Institute, Pen- 
sacola, Rose is the first medical stu- 
dent to complete the flight-surgeon 
syllabus. 

When he finished flight school in 
December 1976, Rose was pre- 
sented a certificate and the promise 
that he would be designated a naval 
flight surgeon when he completed 
the program's usual prerequisites. 

A year and a half of waiting paid 
off on June 30, when Rose's wife, 
Barbara, pinned on his wings. 
Shortly thereafter, Rose was on his 
way to Okinawa, where he will be 
flight surgeon for the First Marine 
Air Wing. 

In the case of this giant tooth, all 
that glitters is indeed gold: it repre- 
sents the response of the Naval 
Regional Dental Center, Camp 
Pendleton, Calif., to this year's 



Navy Relief Fund Drive. 

CAPT B. C. Sharp (DC), com- 
manding officer, and LCDR J. D. 
Galbreath (MSC) point to the 
achievement: $2,534 pledged for 
Navy relief— more than four times 
the assigned $600 goal. 





i 




X: 



I 



h 



Rose: On the wing 




Kunc: CPR training for seagoers 

Volume 69, September 1978 



Sharp & Galbreath: Goldfingers 

23 



Professional 



Bezoar: An Unusual Complication of Surgery 
for Dumping Syndrome 



LCDR Gerald S. Weinstein, MC, USNR 



Interposition of a reversed segment of jejunum be- 
tween the gastric remnant and the duodenum has been 
shown to be an effective treatment for dumping syn- 
drome. This article describes a previously unreported 
complication of this procedure: development of a phyto- 
bezoar. 

Case presentation 

F.B., a 38-year-old white male with a 20-year history 
of duodenal ulcer disease, had undergone truncal va- 
gotomy and pyloroplasty in 1974. 

Immediately following that operation, the patient 
developed severe dumping syndrome accompanied by 
hypoglycemia. Despite antidumping diets, he had 
episodes of flushing, tachycardia, diarrhea, and pros- 
tration six to ten times per day. During these episodes, 
his blood glucose levels were found to be between 20 
and 32 mg/100 ml. 

On 10 Mar 1977, the patient underwent antrectomy 
and reversed jejunal segment interposition, as de- 
scribed by Herrington and Sawyers (1,2). A 10-cm 
segment of jejunum was interposed between the gastric 
remnant and the duodenum. 

The patient's postoperative course was complicated 
by an episode of sepsis, thought to be due to an anasto- 
motic leak. He responded dramatically to antibiotics 
and was discharged on the 25th postoperative day. The 
dumping syndrome and hypoglycemia were completely 
abolished by the operation, and the postoperative 
glucose tolerance test was normal. 

Subsequently, the patient developed early satiety 



From the Department of Surgery, NRMC Newport, R.I. 



02840. 



24 



and delayed gastric emptying. Fiberoptic gastroscopy 
showed narrowing of the gastrojejunal anastomosis. It 
was felt that the patient had developed a stricture sec- 
ondary to an anastomotic leak. 

Revision of the anastomosis and Stamm gastrostomy 
were performed on 15 June 1977. The patient recovered 
well from this procedure and remained asymptomatic 
for approximately two months, when he became inca- 
pacitated by manometry-proved diffuse esophageal 
spasm, refractory to conservative management. On 6 
Sept 1977, he underwent extended esophagomyotomy. 
Fiberoptic gastroscopy at that time was normal. 

Several weeks following this third procedure, the pa- 
tient complained of post-thoracotomy pain and a "ball- 
like" feeling in his abdominal wall. Intercostal nerve 
block relieved the post-thoracotomy pain, but the "ball- 
like" feeling remained. 

On 21 Nov 1977, the patient was readmitted to the 
hospital with severe abdominal pain. Chest and ab- 
dominal X-rays showed the presence of a large food 
mass in a greatly distended gastric remnant (Figure 1). 

A gastrostomy tube was reinserted under local anes- 
thesia, and a solution of commercial meat tenderizer 
(one teaspoon in 30 ml of water) was instilled through 
the tube every four hours. 

Within eight hours, the mass had decreased in size, 
and large pieces of undigested food material could be 
extracted from the gastrostomy tube. 

By the next day, the food mass was approximately 
one half its initial size (Figure 2). This decrease in size 
was associated with relief of the "ball-like" feeling. 

The food mass was gone by the fifth day (Figure 3). 
An upper G.I. series performed prior to the patient's 
discharge showed no evidence of obstruction or exces- 
sively delayed gastric emptying. 

U.S. Navy Medicine 





FIGURE 1. A large mass of undigested food greatly distends 
the gastric remnant. 



On careful questioning, the patient recalled eating as 
many as six to eight nectarines per day for four to six 
weeks following his esophagomyotomy. 



FIGURE 2. After one day of therapy with commercial meat 
tender izer, the food mass is reduced to approximately one 
half its initial size. 



Discussion 

The purpose of reversed jejunal segment interposi- 
tion for dumping syndrome is, of course, to slow gastric 
emptying. Although it may be expected that such a 
situation may provide the setting for formation of a 
phytobezoar, such an occurrence has not been 
reported. 

Enzymatic treatment with commercial meat tender- 
izer, which contains papain, was quite successful and 
demonstrates that nonoperative therapy is possible. 

Patients of this sort should be cautioned against 
eating large amounts of fleshy fruits or other high-resi- 
due foods. 

References 

1 . Herrington JL, Sawyers JL: A new operation for the dumping 
syndrome and post-vagotomy diarrhea. Ann Surg 175:790, 1972. 

2. Sawyers JL, Herrington JLr Superiority of antiperistaltic 
jejunal segments in management of severe dumping syndrome. Ann 
Surg 178:311, 1973. 

Volume 69, September 1978 





FIGURE 3. Five days after patient's admission, food mass is 
entirely gone. Note the presence of the gastrostomy tube. 



25 



Treatment of Chronic Bacterial Prostatitis 
with Trimethoprim-Sulfamethoxazole 



LCDR Donald F. Lynch, Jr., MC, USN 



Chronic bacterial prostatitis is the most common 
cause of relapsing urinary tract infection in the adult 
male (/). It is encountered in both the younger active- 
duty population and the older retired populations, and 
thus presents a therapeutic challenge not only to the 
hospital-based urologist, but also to the dispensary or 
ship-based general medical officer. 

Chronic bacterial prostatitis is always caused by an 
infectious organism, although this is frequently difficult 
to document. The disorder is characterized by variable 
urethral, perineal, or suprapubic pain; mild dysuria; 
decreased stream caliber; and dribbling. Mild discom- 
fort with ejaculation may be present. Urethral dis- 
charge—usually clear and often scanty— is present and 
is often most noticeable in the morning. There is no 
fever. 

Physical Findings are variable, but mild tenderness 
and bogginess of the prostate are frequently noted. 
There is always expressible prostatic secretion, which 
usually contains more than 40 to 60 white blood cells 
per high-power field. 

An additional characteristic is a history of multiple 
previous attempts at treatment, usually with transient 
improvement or temporary cure, but with eventual re- 
currence of symptoms and findings. 

Trimethoprim is a recently developed antibiotic that 
acts against a wide variety of gram- negative and gram- 
positive organisms by inhibiting folate synthesis. It has 
been shown to have an affinity for prostatic tissue, and 
high tissue concentrations can be obtained. When tri- 



methoprim is combined with a sulfonamide, the activi- 
ties of both drugs are enhanced. Because sulfamethox- 
azole has a half-life similar to that of trimethoprim, it is 
used with the latter in a commercially available drug 
preparation, Septra. 

Preliminary indications that trimethoprim-sulfa- 
methoxazole had been effective in the treatment of 
chronic bacterial prostatitis prompted an evaluation of 
this drug in our clinic population. 

Materials and methods 

Thirty-three patients, ranging in age from 23 to 72, 
were treated for chronic bacterial prostatitis between 
August 1975 and February 1977. All had histories of un- 
successful previous treatment for this disorder. 

Two methods of diagnosis were employed. Twenty- 
three patients were diagnosed on the basis of positive 
cultures of expressed prostatic secretions (EPS) or post- 

TABLE 1 . Means of Diagnosis /Organism Cultured 
Source No. of patients Organism cultured 

TRIMETHOPRI SULFAMETHOXAZOLE GROUP 



From the Department of Urology, NRMC San Diego, Calif. 92134. 
Presented at the 25th Kimbrough Urotogical Seminar, Denver, Colo., 

7-11 Nov 1977. 



26 



VB3 
EPS 
"CP" 



11 
5 
8 



(E. coll- 11) 

(E. ooli- 4, Klebsiella- 1) 



VB3 


5 


EPS 


2 


"CP" 


2 



TETRACYCLINE GROUP 



(E. ooli- 5) 
(E. coli- 2) 



U.S. Navy Medicine 



prostatic-massage urines (VB3), as described by 
Meares and Stamey (2). Ten additional patients were 
diagnosed on the basis of irritative and obstructive 
symptoms, prostate examination, urethral discharge, 
and examination of the expressed prostatic secretions, 
as modified after Chesley and Dow (J). This latter 
method was referred to as the "classic picture" ("CP") 
diagnosis, and was an attempt to reproduce diagnostic 
conditions prevailing at small facilities lacking the bac- 
teriologic equipment required to prove the diagnosis by 
culture. 

"Cure" was defined as resolution of symptoms, 
clearing of urethral discharge and prostatic secretions, 
and clearing of cultures. 

"Improvement" was defined as clearing of cultures, 
with partial resolution of symptoms. 

"Failure" was defined as no change in symptoms, or 
relapse to positive cultures, with recurrence of symp- 
toms, within 6 months. 

Two courses of therapy were utilized. One group of 
patients received trimethoprim, 160 mg, and sulfa- 
methoxazole, 800 mg, twice daily for 30 days. A second 
group was treated with tetracycline, 0.5 gm, four times 
daily for 30 days. 

Followup time ranged from 9 to 25 months. Each pa- 
tient was seen at the completion of therapy and at 3 and 
6 months after treatment. Most have been followed 
more than 12 months. VB3 cultures were obtained at 
the completion of treatment and at the 6-month visit. 

Results 

Twenty-four patients were treated with trimetho- 
prim-sulfamethoxazole. Five additional patients were 
allergic to sulfa, and 4 patients presented after having 
tetracycline therapy initiated elsewhere. These 9 
patients were treated with tetracycline. Of 23 patients 
with positive cultures, 22 were due to E. Coli and 1 to 
Klebsiella. The average colony count of the positive 
cultures was 10 4 colonies. The distribution of patients, 
by diagnosis and culture, is shown in Table 1. 

The results of treatment are outlined in Table 2. Fif- 
teen of 24 patients treated with trimethoprim-sulfa- 
methoxazole were cured, and 3 noted improvement. 
Two of 9 patients treated with tetracycline were cured, 
with 1 noting improvement. The response of patients 
diagnosed on the basis of the "classic picture" was 
identical to that of those diagnosed by bacterial culture. 

No drug reactions or other complications of treatment 
were observed. 



TABLE 2. Results of Treatment 
Cured Improved Failed Totals 



TMP-SMZ 


15 (63%) 


3 (13%) 


6 (25%) 


24 


TON 


2 (22%) 


1 (11%) 


6 (66%) 


9 
33 



Discussion 

The diagnosis of chronic bacterial prostatitis is 
complicated by the variability of presenting symptoms 
and the difficulties inherent in obtaining bacterial cul- 
tures from the prostate. Differentiation between mild 
acute prostatitis, abacterial prostatitis or prostatosis, 
and chronic bacterial prostatitis may, at times, be im- 
possible. 

The results of other evaluations of trimethoprim- 
sulfamethoxazole in the treatment of chronic bacterial 
prostatitis are shown in Table 3. The variation in treat- 
ment periods, ranging from 28 days to 12 weeks, makes 
precise comparison difficult, but the results of the pre- 
sent study are encouraging. 

The culture techniques advocated by Meares and 
Stamey are useful in documenting infection of the pros- 
tate (2,4). The bacterial cultures obtained in this study, 
using their techniques, are consistent with infection 
patterns noted by other investigators (4.6. 7). Culture of 
the semen rather than of expressed prostatic secre- 
tions, while not utilized here, has been successfully 
employed and should receive additional evaluation (5). 

Drach has observed that trimethoprim was more ef- 
fective in curing prostatitis due to gram-negative orga- 
nisms than that due to gram-positive organisms (6). 
The fact that only gram-negative organisms were cul- 
tured from patients in this study may partly explain the 
improved cure rate observed. 

TABLE 3, Comparison with Other Studies 



Study 


Cure rate 


Chesley and Dow (1973) 


47% 


Drach (1974) 


33% 


Meares (1975) 


31% 


McGuireand Lytton (1976) 


33% 


Present study 


63% 



Volume 69, September 1978 



27 



The "classic picture" diagnosis of chronic bacterial 
prostatitis, while less scientific than diagnosis from 
bacterial cultures, is still widely used (3,8). The finding 
of white blood cells in the prostatic secretions, by itself, 
has been shown to be an unsatisfactory criterion for 
diagnosing chronic prostatitis (9,10). In the absence of 
a dependable bacteriology laboratory, microscopic 
examination of the prostatic secretions, combined with 
a careful history and physical examination, can be 
useful in making the decision to initiate therapy. 

The mean age of the patients in the trimethoprim- 
sulfamethoxazole group was 38 years. Cure was 
achieved in 12 of 16 patients (75%) under 40 years of 
age. Of the 8 patients over 40, 3 (38%) were cured. 
More than half of the patients in Drach's study were 
over 40 years old (6). Age was not addressed by other 
investigators, but it is suspected that the preponder- 
ance of these patients were over 40. In older patients, 
the presence of prostatic calculi, benign prostatic 
hypertrophy, or other lower urinary tract obstruction 
can perpetuate infection and hamper therapy. The im- 
proved cure rate achieved in the present study is prob- 
ably a reflection of the large number of younger pa- 
tients treated. 

Although the data presented are limited, this study 
suggests that the combination drug trimethoprim- sulfa- 
methoxazole represents a major advance in the treat- 



ment of chronic bacterial prostatitis. A 30-day course of 
therapy can produce complete cure, especially in pa- 
tients under 40, and long-term treatment with low 
doses may afford relief in patients for whom complete 
cure cannot be achieved. The results of this study imply 
superiority of this drug regimen over the standard 
tetracycline regimen that has been used for this dis- 
order. 

References 

1. Meares EM: Bacterial prostatitis vs "prostatosis." JAMA 
224:1372-1375, 1973. 

2. Meares EM, Stamey TA: Bacterial localization patterns in 
bacterial prostatitis and urethritis. Invest Urol 5:492-518, 196S. 

3. Chesley AE, Dow D: Use of trimethoprim -sulfamethoxazole in 
chronic prostatitis. Urology 2:280-282, 1973. 

4. Meares EM: Prostatitis: a review. Urol Clin North Am 2:3-27, 
1975. 

5. McGuire EJ, Lytton B: Bacterial prostatitis: treatment with 
trimethoprim-sulfamethoxazole. Urology 7:499-501, 1976. 

6. Drach GW: Trimethoprim-sulfamethoxazole therapy of bac- 
terial prostatitis. J Urol 111:637-639, 1974. 

7. Drach GW: Prostatitis: man's hidden infection. Urol Clin North 
Am 2:499-520, 1975. 

8. Brannan W: Treatment of Chronic Prostatitis. Urology 5:626- 
631, 1975. 

9. Bowers JE, Thomas GB: Clinical significance of abnormal 
prostatic secretions. J Urol 79:976-982, 1958. 

10. Bourne CW, Frishette WA: Prostatic fluid analysis and prosta- 
titis. J Urol 97:140-144, 1967. 



Notes from the I.G., Medical 



Surplus equipment. In numerous 
activities, equipment that has be- 
come surplus to the needs of the 
command is stored in various places 
without an active disposal program. 
It is recommended that commands 
review their procedures for disposal 
of equipment no longer required. 
Uncollectable accounts. At some 
commands, uncollectable accounts 
for patient care have not been 
properly followed up. The result has 
been excessively high amounts in 
"accounts receivable." It has been 
determined advantageous that the 
Naval Investigative Service (NIS) be 
informed of the names of individ- 
uals with deliquent accounts, since 
the same individuals may possibly 
pass bad checks in the commissaries 
and exchanges or engage in other 
activities of an illegal nature. There- 
fore, we recommend that the names 
of individuals with past-due ac- 



2S 



counts be provided NIS for their in- 
formation. 
BMET and Public Works personnel. 

We remind commands that, prior to 
purchase of new equipment, BMET 
or Public Works personnel (or both, 
depending upon the type of equip- 
ment) should receive training in the 
operation and maintenance of this 
equipment. 

In-service training programs. There 
is a need for continued emphasis on 
improvement of the enlisted In-Ser- 
vice General Military Training Pro- 
grams. In the development of these 
programs, consideration should be 
given to ensuring that: 

• Only outstanding and highly 
qualified personnel are assigned as 
instructors, and that equally quali- 
fied personnel are assigned as sub- 
stitutes whenever the principal 
instructor is unavailable. 

• Lesson plans be submitted to, 



and reviewed by, the In-Service 
Training Officer, Nursing Education 
Coordinator, or Chief of Service to 
which the lesson plan refers to en- 
sure appropriateness and validity of 
topic. 

• Local instructions on attend- 
ance and excused absences are 
complied with. 

• The In-Service Training Officer 
and Nursing Education Coordinator 
concurrently develop, organize, and 
administer the program. 

• Class schedules be prepared 
and promulated to provide sufficient 
lead-time notification to attendees 
and instructors. 

• Appropriate records of in-ser- 
vice training be maintained to en- 
sure required documentation of 
eligibility for advancement in rate. 

BUMEDINST 1510.8 is the appli- 
cable instruction. 

— RADM Melvin Museles, MC, USN 

U.S. Navy Medicine 



BUMED SITREP 



ASBESTOS SURVEILLANCE . . . VADM Willard P. 
Arentzen (MC), Navy Surgeon General, has announced 
establishment of an expanded medical surveillance pro- 
gram for all Navy uniformed and civilian personnel 
potentially exposed to airborne asbestos. 

In CY 1977, an estimated 14,000 Navy personnel 
were examined to meet requirements of DOD Occupa- 
tional Safety and Health Regulations. It is estimated 
that as many as 70,000 civilian and 150,000 active-duty 
personnel will be included in the new program, which 
has been expanded to cover all present Navy civilian 
and uniformed personnel who may have had past occu- 
pational exposure to airborne asbestos, or who are 
potentially exposed to low levels of akborne asbestos. 

Implementation of the program will include hiring of 
55 additional Medical Department personnel for Navy 
medical care facilities and expenditure of approxi- 
mately $1 .6 million in the first year. 

In phase one of the program, all current uniformed 
and civilian employees who may ever have been ex- 
posed to asbestos will be identified by the completion of 
a questionnaire. In phase two, those who have been 
potentially exposed will be interviewed and receive a 
medical examination, including recording of their occu- 
pational and respiratory history, physical examination 
of the chest, chest X-ray, and pulmonary function tests. 

Personnel whose medical examinations show evi- 
dence of lung change compatible with asbestos expo- 
sure will have their medical records flagged for surveil- 
lance with an annual medical examination for the dura- 
tion of their federal service. Those whose question- 
naires and interviews indicate a history of asbestos ex- 
posure, but who show no present evidence of asbestos- 
related physical change, will be scheduled for future 
medical examinations at least once every five years. Be- 
cause of the unique high-risk relationship between 
smoking and exposure to airborne asbestos, all regular 
smokers with an exposure history, as determined by the 
survey, will be placed in the medical surveillance pro- 
gram and receive annual examinations. 

The Navy is adopting a "medical surveillance action 
level" that will require medical examination for all in- 
dividuals who, in the course of employment, are re- 
quired to enter or work, "on a regular basis," in areas 
containing airborne asbestos concentration of 0.5 
fibers greater than 5 micrometers in length, per cubic 
centimeter of air, as determined by phased contrast 
microscopy. This means that more Navy people will be 
monitored than would ordinarily be included under the 
current standards for asbestos-exposed workers. 



The new standards define "on a regular basis" as 
exposure for 15 days in any calendar quarter, or 45 days 
per year. Additionally, individuals exposed above a 
"ceiling limit" of 10 fibers per cc of air at any time will 
be placed in the medical surveillance program. 



PAP SMEAR PROBLEM . . . Women who had a pap 
smear at an Air Force medical facility between June 
and September 1977 and have not been subsequently 
reexamined should contact the facility immediately to 
determine whether a reexamination is necessary. 

The Air Force recently discovered that some pap 
smears taken at 94 Air Force facilities throughout the 
world may have been misclassified by an Air Force 
contractor. 

Since 1 July 1972, the Air Force has used the services 
of this contractor periodically. As an extra precaution, 
women who had pap smears at an Air Force facility 
between 1 July 1972 and May 1977 — and have not had 
one other than at an Air Force installation since then — 
should consult a doctor to determine if a reexamination 
is required. 



CORRECTION ... The Navy Editor Service recently 
listed the Navy Physician's Assistant Program, Navy 
Enlisted Nursing Education Program, and Navy En- 
listed Dietetic Education Program as "paths to a com- 
mission. ' ' This information was erroneous and will be 
corrected by NES; nonetheless, it may crop up in 
current Navy publications. 

The programs referred to are no longer in existence. 
The Physician's Assistant Program is being revised and 
will be reinstituted in the coming year. Eligibility and 
application procedures are being finalized at this time. 



AUDIT TIPS . . . The following discrepancies were 
noted on a recently completed audit: 

• Establish separate bulk storage areas for Navy stan- 
dard stock and commercial distributor provisions items. 

• Revise current procedures for custody and handling 
of keys to comply with the guidelines established by 
NAVSUP P-486, para. 1056. 

• Ensure that shelf-life items are identified, controlled, 
and inspected in accordance with NAVSUP Manual 
para. 21108-24031 and NAVMEDMATSUPPCOM- 
FMSO Instruction 4000.1. 



Volume 69, Septemt-ar 1978 



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